APME-362; No.

of Pages 3

apollo medicine xxx (2016) xxx–xxx

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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
Endobronchial tuberculosis is tubercular infection of the
tracheobronchial tree. It can have a varied presentation
including lobar collapse and consolidation. The case discussed
here is an unusual presentation of endobronchial tuberculosis
as a total lung collapse.
2. Case report
An 18-year-old female presented with history of fever, loss of
appetite and weight, of 3 months duration. She had no
significant past medical illnesses and no past history of
bronchial asthma. She denied any respiratory complaints but
hemithorax and CXR showed complete collapse of left lung
with a bronchial cut-off sign (Fig. 1). CT chest showed complete
collapse of her left lung (Fig. 2).
Flexibronchoscopy was done which showed caseous
material occluding the left main bronchus beyond which
scope could not be passed. Bronchial wash for AFB smear, AFB
culture and gene expert were negative. However, in view of
clinical features consistent with pulmonary Koch's and
bronchoscopy suggestive of endobronchial tuberculosis, the
patient was started on anti-tuberculous therapy with isonia-
zid, rifampicin, ethambutol and pyrazinamide with steroids.
Unfortunately, she developed ATT-induced hepatotoxicity
within a week of starting treatment and was shifted to less
hepatotoxic regimen with isoniazid, ethambutol and oflox-
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. 1 – CXR showing total left lung collapse.
Fig. 2 – CT showing total left lung collapse.
CXR done after 4 weeks showed complete re-expansion of the
collapsed lung (Fig. 3).
Currently, she is afebrile, has good appetite, gained weight
and has good radiological clearance and is continuing ATT and
is on regular follow-up.
3. Discussion
Endobronchial tuberculosis is the manifestation of tubercular
infection of mucosa and sub-mucosa of tracheobronchial
tree.1
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
Fig. 3 – Repeat CXR after 4 weeks showing re-expansion of
the lung.
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.
Typically, there is associated distal lobar collapse.
Sputum smear positivity has been observed to be only
15–20% in endobronchial tuberculosis.2
Bronchoscopy and bronchial sampling is the key to
diagnosis of endobronchial tuberculosis. Bronchoscopy may
show exudates, ulcers and cicatrisation in later stages. Lymph
nodes may erode the bronchus and discharge the caseous
material endobronchially.
In this patient, bronchoscopy showed the typical caseous
material endobronchially but it could not be removed to open
up the bronchus.
Treatment of endobronchial tuberculosis is the same as for
Pulmonary Tuberculosis. Role of corticosteroids is controver-
sial but has been given for preventing bronchial stenosis as
was done for this patient. Long-term sequelae including
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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