Is Drug Therapy Sufficient in Endobronchial Tuberculosis- Post-treatment Airways Stenosis Requiring Lobectomy

Abstract

A 23-year-old-female presented with complaints of right sided chest pain, cough and fever of 2 months duration that remained unresponsive antibiotics. Her chest radiograph showed homogenous opacity in right middle and lower zone & HRCT chest showed collapsed right middle and lower lobes with fluid filled bronchi. Bronchoscopy showed pus like secretions in right main bronchus and whitish mucus plugs in right middle and lower lobe bronchi causing significant luminal narrowing. Acid Fast Bacilli (AFB) were detected in bronchial washings and caseating granulomas were found on bronchial biopsies, diagnostic of endobronchial tuberculosis (EBTB). She completed 9 months of standard anti-tuberculous treatment along with 1 month course of prednisolone. One year after completion of treatment, the patient started experiencing recurrent episodes of cough productive of purulent sputum (AFB negative) that responded to antibiotics on temporary basis. Repeat HRCT showed right lower lobe segments filled with purulent secretions and bronchoscopy revealed distorted and stenotic lower lobe segmental bronchi. Repeated infections in right lung required curative Video Assisted Thoracoscopic Surgery (VATS)-assisted resection of right lower lobe.