CRA37 BRONCHOSCOPIC BALLOON DILATATION WITH TOPICAL MITOCIN C APPLICATION FOR BRONCHIAL STENOSIS SECONDARY TO ENDOBRONCHIAL TUBERCULOSIS

Chun Hau Lam, Jen Lye Wan, Noor Izyani Zakaria, Shivaanand Letcheminan

Respiratory Department, Selayang Hospital, Selangor, Malaysia

Background
Tuberculosis (TB) remains a devastating disease with far-reaching consequences even after microbiological cure. One significant non-infective complication is post-tuberculous bronchial stenosis (PTBS), arising from healing-related fibrosis and scarring. PTBS is a common sequela of endobronchial TB, often leading to fixed airway obstruction, impaired lung function, and significant morbidity. Bronchoscopic balloon dilatation (BBD), especially when combined with topical Mitomycin C offers a promising minimally invasive treatment. However, managing PTBS remains challenging, particularly in cases with associated airway malacia or recurrent stenosis.

Case Presentation
We report a case of a 21-year-old woman who developed exertional dyspnea on Day 121 of the maintenance phase of antituberculosis therapy. A chest radiograph (CXR) revealed complete opacity of the left lung, later confirmed on CT thorax to be due to left main bronchus (LMB) obstruction. The patient underwent successful bronchoscopic recanalization of the LMB at Hospital Sultan Idris Shah (Serdang), which initially restored airway patency.

However, at a subsequent follow-up visit, repeat CXR revealed left lung collapse which was confirmed to be recurrent LMB stenosis via a surveillance bronchoscopy. After counselling, she underwent repeat BBD combined with topical Mitomycin C application under general anaesthesia at Hospital Selayang. This was the first instance of such a procedure being performed at Hospital Selayang. The process was not without logistical hurdles—chiefly in procuring rigid bronchoscopy equipment and a compatible light source, which had to be borrowed from the Otorhinolaryngology (ENT) department.

Results
Post-procedure imaging showed re-expansion of the left lung. Despite clinical improvement, the patient required a subsequent balloon dilatation procedure, highlighting the recurrent nature of PTBS and the need for serial interventions to maintain airway patency.

Conclusion
BBD with topical Mitomycin C, is a viable therapeutic strategy for TB-related bronchial stenosis. However, PTBS poses multiple management challenges, including airway malacia, recurrence, and the need for repeated procedures. This case not only underscores the persistent burden of TB-related airway disease but also illustrates the interdepartmental collaboration required to manage such complex cases effectively.