Inside the Bronchus

Abstract

Tumor necrosis factor inhibitors contribute to a greater susceptibility to infection or reactivation of Mycobacterium tuberculosis. Endobronchial tuberculosis has non-specific symptoms, which may delay the diagnosis. We report a case of a 21-year-old woman, with Crohn’s disease, medicated with adalimumab. The patient presented with a 2-week history of fever, dry cough, pleuritic chest pain and weight loss of 2 kg. Chest imaging showed bilateral nodular opacities, at the right pulmonary apex. Bronchoscopy revealed a tumorous lesion in the right upper bronchus. Bronchial biopsies were suggestive of chronic granulomatous inflammation. Bronchoalveolar lavage produced a positive for acid-fast bacilli smear and culture for Mycobacterium tuberculosis. We assumed the diagnosis of tuberculosis with endobronchial manifestations. Nowadays this is a rare manifestation. Empirical treatment for tuberculosis was initiated, with steroids as an adjunct therapy to prevent bronchostenosis, with clinical and radiological improvement.