Bronchial Tuberculosis With a Longitudinal Ulcer in the Bronchial Mucosa

Abstract

Background. Even at present, when therapeutic choices for tuberculosis are well established, bronchial tuberculosis remains a condition deserving special attention. Some of the reasons for this are as follows: the diagnosis often tends to be delayed, residual bronchial narrowing tends to frequently occur even after treatment of the infection, and in the early stage the condition often tends to be mistaken for bronchial asthma or bronchial tumor. Patient. A 27-year-old Indonesian man presented with a history of dry cough since December 2003; he received treatment at another hospital, but since no improvement was noted, he was referred to our hospital. A chest CT revealed huge hilar and mediastinal lymphadenopathy, and the tuberculin test reaction was positive. Bronchoscopy revealed a longitudinal ulcer on the lateral wall of the right truncus intermedius. Bronchial biopsy revealed granulomatous inflammation with epithelioid cells and a central area of caseous necrosis, however, smears of sputum and bronchoscopy were negative for acid-fast bacilli smears and PCR. The QuantiFERON-TB (QFT) test, conducted as an adjunctive test, was positive. Results. Based on the above observations, the patient was clinically diagnosed to have bronchial tuberculosis. Treatment with oral anti-tuberculous drugs induced improvement of the membranous findings. Subsequently, culture of the bronchial washings was also found to be positive for tubercle bacilli, leading to a definitive diagnosis of bronchial tuberculosis. Conclusion. The present case is considered noteworthy, in that early diagnosis of bronchial tuberculosis was made, despite the presence of relatively uncommon bronchoscopic findings.