Tuberculosis bronchitis with normal chest x-ray among a large bronchoscopic population

A 36-year-old Man With Endobronchial Lesion and Bony Destruction of Ribs and Sacrum

A 36-year-old male nonsmoker with fever, dyspnea, and cough of 2 weeks' duration presented to the emergency department. He reported left pleuritic chest pain and weight loss for the last 2 months. Chest radiology revealed a left lower lobe mass, a liver lesion, and bony destruction of right sacrum and ribs. Flexible bronchoscopy (FB) revealed an endobronchial (EB) tumorous lesion with cheesy material occluding the left lower lobe. Biopsies and cultures of the lung and rib lesions supported the diagnosis of tuberculosis (TB). Antituberculous therapy was started with rapid clinical improvement. A follow-up FB revealed partial resolution of the EB lesion. EBTB is a rare finding in the developed countries and the association with multiple skeletal and liver lesions is extremely rare. An EB lesion with skeletal lesions usually suggests malignancy or infectious diseases such as EB actinomycosis and fungal infections. The incidence of EBTB varies based on the population reported and has been described in children and young adults. Now, with an increase in international traveling and globalization, it is important for clinicians to include EBTB as a part of the differential diagnosis in patients presenting with EB lesions with or without associated systemic involvement. Early diagnosis and treatment could decrease the morbidity and potential development of bronchial stenosis associated with the disease. FB is highly recommended to identify those patients with poor prognosis who need close monitoring and bronchoscopic follow-up.