Tuberculous endobronchial stenosis in an adolescent: a rare case report.

Abstract

The prevalence of post-tuberculous endobronchial stenosis in children is unknown and it is rarely reported. In adults, it varies from 10% to 40%. It has a variable spectrum of presentation; cough is the most common, but there can also be haemoptysis, dyspnoea, chest pain and wheezing. The non-specific symptoms and co-occurrence with parenchymal disease can delay the diagnosis. Bronchoscopy and computed tomography (CT) are the investigations of choice. Depending on the symptoms, chest imaging and bronchoscopic findings, the treatment can be conservative, medical or interventional. A 15-year-old male is presented; he was a known case of clinically and radiologically diagnosed pulmonary tuberculosis and was treated for 6 months with anti-tuberculous drugs. On presentation, there was a progressive cough, exertional dyspnoea, collapse consolidation of the left lung, ipsilateral mediastinal shift and partial stenosis of the left distal main bronchus on contrast-enhanced CT. Flexible fibre-optic bronchoscopy demonstrated atresia of the anterior segment and stenosis of the inferior lingular segment of the left bronchus with a normal right bronchus. Post-tuberculous bronchial stenosis should be focused on and managed early to prevent fibro-stenosis. Early treatment in a symptomatic patient is linked to a successful outcome. The boy showed significant clinical improvement with spirometry, chest physiotherapy and supportive measures, although the radiological features persisted.Abbreviations: ATT: anti-tuberculous therapy; CT: computed tomography; EBTB: endobronchial tuberculosis; ESR: erythrocyte sedimentation rate; HRCT: high-resolution computed tomography; LUL: left upper lobe; TB: tuberculosis.