Chest Infections |

A Rare Cause of Chronic Cough in a Teenager: Endobronchial Tuberculosis FREE TO VIEW

Roxana Nemes*, PhD; Emilia Tabacu, PhD; Emilia Crisan, PhD; Ruxandra Ulmeanu, PhD; Ramona Nedelcu, MD; Paraschiva Postolache, PhD; Florin Mihaltan, PhD
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Institute of Pulmonology, Bucharest, Romania

Chest. 2012;142(4_MeetingAbstracts):252A. doi:10.1378/chest.1389149
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SESSION TYPE: Infectious Disease Global Case Report Posters

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: Endobronchial tuberculosis (EBTB) are not among the most common causes of chronic cough. EBTB is present only in 10-20% of patients with normal chest Xray. (#1)

CASE PRESENTATION: A 19 year old female, nonsmoker, was admitted with complaints of dry cough for two months along with low fever (37,2°C). Before admission patient had been treated by local physicians and she had taken several oral antibiotics, without clinical results. Gastroesophageal reflux were excluded after gastroendoscopy. Our patient was HIV negative. Physical examination reveal weight loss, voice change and unilateral wheeze. Blood biochemistry, serology, lung function (FEV1 82 %predicted, FVC 80% predicted) and chest X-ray were normal. The key to diagnosis is bronchoscopic examination. The bronchoscopic exam reveals extension lessions from lower part of trachea to intermediate right bronchus with narrowing of the lumen of variable extent throughout the right bronchial tree. BAL fluid analysis show positive Ziehl Nielsen stain in smear examination and that was negative after 4 weeks TB treatment. Early diagnosis with prompt treatment is important to prevent the serious complications of EBTB. Antituberculous chemotherapy is effective in controlling the infection but may not preclude residual bronchostenosis (60-95%)(#2). Our patient has residual stenosis of the right main bronchus but complete clearing of EBTB on a follow-up bronchoscopy exam performed 2 month later. Corticosteroid therapy for the prevention of bronchial stenosis remains controversial.

DISCUSSION: The clinical presentation of EBTB is variable. A barking cough is the most common symptom. Persistent unilateral wheeze is indicative of EBTB. A clear chest X-ray does not exclude the diagnosis because the X-ray appearances may be normal in 20% of patients

CONCLUSIONS: Diagnosis of EBTB is often mistaken and delayed. For early diagnosis, a high index of awareness of this disease is required and the bronchoscopy should be performed as soon as possible in suspected patients

1) Lee JH, Park SS, Lee DH, Yang SC, Yoo BM. Endobronchial tuberculosis : Clinical and bronchoscopic features in 121 cases. Chest 1992; 102 : 990-94.

2) Chung HS, Lee JH. Bronchoscopic assessment of the evolution of endobronchial tuberculosis. Chest 2000; 117 : 385-92.

DISCLOSURE: The following authors have nothing to disclose: Roxana Nemes, Emilia Tabacu, Emilia Crisan, Ruxandra Ulmeanu, Ramona Nedelcu, Paraschiva Postolache, Florin Mihaltan

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Institute of Pulmonology, Bucharest, Romania




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