SESSION TYPE: Infectious Disease Student/Resident Case Report Posters I
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Endobronchial tuberculosis TB can present as a mass lesion in adults. We present a case of chronic silicosis complicated by TB presenting as endobronchial tumor mimicking lung cancer on bronchoscopic examination.
CASE PRESENTATION: A 90-year-old ex-smoker presented to us with chest pain and progressive dyspnea. His occupational history included working in a brick plant for 35 years. On physical examination he was well nourished with normal vital signs. Examination of the chest revealed dullness to percussion and bronchial breath sounds over the apices as well as tenderness over the right anterior chest. Biochemistry and hematology investigations were normal. Chest X-ray demonstrated ill-defined opacities involving lung apices and a soft tissue density involving the right middle lobe. Thoracic computed tomography (Figure 1) showed multiple spiculated soft tissue densities involving bilateral upper lobes and a pedunculated soft tissue lesion in the right main stem bronchus with left hilar and mediastinal adenopathy. Bronchoscopy (Figure 2) revealed a friable white mass surrounded by dark mucosa, obstructing bronchus intermedius. A high suspicion of malignancy was present at that time. However, histopathological examination revealed anthracosilicosis, positive FITE stain for acid fast bacilli and no malignancy (Histopathology images will be available for the poster). Bronchial lavage culture and quantiferon gold test were performed and both were positive for Mycobacterium tuberculosis.
DISCUSSION: The risk of developing pulmonary TB is 2.8 to 39 times higher in patients with silicosis . The most common form of endobronchial TB is mucosal hyperemia and erosions leading to ulceration and granulation tissue . Cough is the most common symptom and the most serious complication is bronchial stenosis, which was demonstrated in our case. Occupational history, radiology (chest radiography and computed tomography) and microbiology are helpful for the correct diagnosis. Silicosis is an untreatable disease. On the other hand, silicotuberculosis can be successfully managed with timely diagnosis and commencement of early treatment. Our patient completed anti tuberculous chemotherapy with significant resolution both symptomatically and radiologically.
CONCLUSIONS: Recognition of tuberculosis in patients with silicosis can be challenging due to the insidious onset of symptoms and the underlying radiographic abnormalities. This case report is a reminder that endobronchial tuberculosis must be taken into consideration in the differential diagnosis of endobronchial lesions in patients with silicosis.
1) Cowie RL(1994) The epidemiology of tuberculosis in gold miners with silicosis. American Journal of Respiratory and Critical Care Medicine 150(5):1460-1462
2) Saleemi S, Khalid M, Zeitouni M, Al-Dammas S(2004) Tuberculosis presenting as endobronchial tumor. Saudi Med J. 25(8):1103-5.
DISCLOSURE: The following authors have nothing to disclose: Dina Ahmad, Dennis Chairman, Mohammad Esmadi, John Onofrio
No Product/Research Disclosure InformationDepartment of Internal Medicine, University of Missouri School of Medicine, Columbia, MO