Endobronchial Tuberculosis: from Diagnosis to Management and Quality of Life- A Case Report

Author(s): Teodora Butnaru, Florin Dumitru Mih?l?an, Adam Andrei, Diana Cocuz, Ancu?a Alina Constantin

Despite rapid advances in diagnostic and treatment modalities, endobronchial tuberculosis (EBTB), the particular form of tuberculosis defined as infection of the tracheobronchial tree caused by Mycobacterium tuberculosis, continues to remain a challenge for clinicians. Non-specific respiratory symptoms as well as normal radiological appearance (10-20% of cases) can be invoked for the delay in diagnosis. The bacteriological examination of the sputum smear has a low diagnostic yield. The positivity of the sputum smear varies between 16 and 53%, so a negative result does not exclude the diagnosis. In such cases, high-resolution computed tomography (HRCT) functions as a more sensitive tool and demonstrates the involvement of the tracheobronchial tree classically described as "tree-in-bud" appearance. Bronchoscopic biopsy is considered the most reliable method of confirming the diagnosis with a yield of 30% to 84%. The evolution of the disease is unpredictable, with a frequent progression to bronchial stenosis, therefore it requires regular follow-up and early intervention. The quality of life of patients with EBTB is affected both because of the debilitating symptoms and the side effects of treatment. Tracheobronchial stenosis, a common complication, can turn patients into chronic sources of infection or cause serious pulmonary complications. In this context, we present the clinical case of a 40-year-old patient with persistent cough syndrome, diagnosed with endobronchial tuberculosis by bronchoscopy, later confirmed by positive cultures for Mycobacterium tuberculosis. Treatment included the standard treatment regimen, adjusted to manage adverse reactions. This case highlights the importance of early diagnosis and appropriate management to improve quality of life and reduce EBTB-associated morbidity.