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APME-362; No.

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Case Report

Unusual case of total lung collapse due to


endobronchial tuberculosis – A case report

V. Vinod Kumar *
Consultant Pulmonologist, Apollo First Med Hospital, India

article info abstract

Article history: An 18-year-old female with history of fever and loss of weight was found to have a total lung
Received 11 August 2015 collapse during imaging. Flexibronchoscopy was consistent with endobronchial tuberculo-
Accepted 19 March 2016 sis and the patient was started on anti-tuberculous treatment. She responded well to
Available online xxx treatment and the collapsed lung opened up spontaneously in 4 weeks. This case is
presented here due to unusual presentation of endobronchial tuberculosis as a total lung
Keywords: collapse.
Collapse # 2016 Indraprastha Medical Corporation Ltd. Published by Elsevier B.V. All rights
Tuberculosis reserved.
Endobronchial
Bronchial cut off
Bronchoscopy

on examination there was absent breath sounds in the left


1. Introduction
hemithorax and CXR showed complete collapse of left lung
with a bronchial cut-off sign (Fig. 1). CT chest showed complete
Endobronchial tuberculosis is tubercular infection of the collapse of her left lung (Fig. 2).
tracheobronchial tree. It can have a varied presentation Flexibronchoscopy was done which showed caseous
including lobar collapse and consolidation. The case discussed material occluding the left main bronchus beyond which
here is an unusual presentation of endobronchial tuberculosis scope could not be passed. Bronchial wash for AFB smear, AFB
as a total lung collapse. culture and gene expert were negative. However, in view of
clinical features consistent with pulmonary Koch's and
bronchoscopy suggestive of endobronchial tuberculosis, the
2. Case report
patient was started on anti-tuberculous therapy with isonia-
zid, rifampicin, ethambutol and pyrazinamide with steroids.
An 18-year-old female presented with history of fever, loss of Unfortunately, she developed ATT-induced hepatotoxicity
appetite and weight, of 3 months duration. She had no within a week of starting treatment and was shifted to less
significant past medical illnesses and no past history of hepatotoxic regimen with isoniazid, ethambutol and oflox-
bronchial asthma. She denied any respiratory complaints but acin. The patient improved well with treatment and repeat

* Tel.: +91 9443076049.


E-mail address: drvinodkumar_v@yahoo.com
http://dx.doi.org/10.1016/j.apme.2016.03.006
0976-0016/# 2016 Indraprastha Medical Corporation Ltd. Published by Elsevier B.V. All rights reserved.

Please cite this article in press as: Vinod V. Unusual case of total lung collapse due to endobronchial tuberculosis – A case report, Apollo
Med. (2016), http://dx.doi.org/10.1016/j.apme.2016.03.006
APME-362; No. of Pages 3

2 apollo medicine xxx (2016) xxx–xxx

Fig. 3 – Repeat CXR after 4 weeks showing re-expansion of


the lung.

Fig. 1 – CXR showing total left lung collapse.


Primary tuberculosis of bronchus is rare. Tracheobronchial
infection is usually due to spread from parenchymal focus.
Lymphatic and haematogenous spread can also occur.1
Endobronchial tuberculosis occurs most commonly in
young adult females. It can have a varying presentation. In
acute presentation, disease simulates asthma, foreign body
aspiration or pneumonia. Patients with insidious onset may
have disease mimicking bronchogenic carcinoma.2
Findings on chest radiology are variable. It may show
patchy infiltrates, collapse, consolidation, cavitation, pleural
effusion, miliary shadows and mediastinal lymphadenopathy.
Chest radiograph may even be normal in 10% of cases.1,2
This case is unique in that endobronchial tuberculosis
presenting as a total lung collapse with a typical bronchial cut-
off sign is rare. The bronchial cut-off sign refers to the abrupt
truncation of a bronchus from obstruction, which may be due
to cancer, mucous plugging, trauma or foreign bodies.
Fig. 2 – CT showing total left lung collapse.
Typically, there is associated distal lobar collapse.
Sputum smear positivity has been observed to be only
15–20% in endobronchial tuberculosis.2
CXR done after 4 weeks showed complete re-expansion of the Bronchoscopy and bronchial sampling is the key to
collapsed lung (Fig. 3). diagnosis of endobronchial tuberculosis. Bronchoscopy may
Currently, she is afebrile, has good appetite, gained weight show exudates, ulcers and cicatrisation in later stages. Lymph
and has good radiological clearance and is continuing ATT and nodes may erode the bronchus and discharge the caseous
is on regular follow-up. material endobronchially.
In this patient, bronchoscopy showed the typical caseous
material endobronchially but it could not be removed to open
3. Discussion
up the bronchus.
Treatment of endobronchial tuberculosis is the same as for
Endobronchial tuberculosis is the manifestation of tubercular Pulmonary Tuberculosis. Role of corticosteroids is controver-
infection of mucosa and sub-mucosa of tracheobronchial sial but has been given for preventing bronchial stenosis as
tree.1 was done for this patient. Long-term sequelae including

Please cite this article in press as: Vinod V. Unusual case of total lung collapse due to endobronchial tuberculosis – A case report, Apollo
Med. (2016), http://dx.doi.org/10.1016/j.apme.2016.03.006
APME-362; No. of Pages 3

apollo medicine xxx (2016) xxx–xxx 3

bronchial and tracheal stenosis have been reported despite references


treatment.

1. Satya Sri S. Textbook of Pulmonary and Extrapulmonary


Conflicts of interest Tuberculosis. 4th ed. Mehta Publishers; 2011:106–108.
2. Sharma SK. Tuberculosis. Jaypee; 2011:163–168.
The author has none to declare.

Please cite this article in press as: Vinod V. Unusual case of total lung collapse due to endobronchial tuberculosis – A case report, Apollo
Med. (2016), http://dx.doi.org/10.1016/j.apme.2016.03.006