CRA13 TUMOR OR TUBERCULOSIS? UNMASKING ENDOBRONCHIAL TUBERCULOSIS IN A YOUNG ADULT

Anandprakash Sivapirakasam, Sunita Devi Hukam Gopal Chand
Hospital Sultan Abdul Halim, Kedah, Malaysia

Introduction
Endobronchial tuberculosis (EBTB), a formidable and often overlooked manifestation of pulmonary tuberculosis (TB), can masquerade as chronic bronchitis or malignancy. Its insidious nature and often smear-negative presentation make early diagnosis challenging yet essential to prevent irreversible airway damage.

Objectives
To underscore the indispensable role of bronchoscopy in unveiling EBTB in a young, otherwise healthy adult with prolonged respiratory symptoms and high occupational TB exposure.

Methodology
A 22-year-old Malay policeman and active smoker, with chronic cough and whitish sputum for 8 months, initially treated for pseudomonas community-acquired pneumonia, remained symptomatic despite antibiotics. Radiographic evaluation revealed a left pleural effusion with adjacent consolidation. Sputum acid fast bacilli (AFB) were persistently negative. Diagnostic bronchoscopy exposed nodular lesions in the left main bronchus, prompting biopsy and bronchoalveolar lavage (BAL).

Results
Histopathology revealed non-caseating granulomas; Gene Xpert MTB/RIF from bronchial tissue detected Mycobacterium tuberculosis. Diagnosis of Endobronchial tuberculosis (EBTB), timorous type made. BAL AFB and cultures remained negative. Anti-TB therapy was initiated. Re-evaluation bronchoscopy after completion of treatment revealed bronchial scarring with resolution of active disease. The patient showed marked clinical improvement.

Conclusions
This case reinforces bronchoscopy as a cornerstone diagnostic modality in suspected EBTB, especially when conventional sputum studies are inconclusive. In high-risk populations with persistent respiratory symptoms, early endoscopic evaluation is vital for early accurate diagnosis and timely intervention resulting in prevention of long-term sequelae such as bronchial stenosis.