Phenotyping and treatment of endobronchial Tuberculosis: A Case Series

Introduction: Endobronchial tuberculosis(EBTB) is present in 10-40% of patients with active pulmonary tuberculosis and those with with EBTB may have some degree of bronchial stenosis. Materials & Methods: 6 cases of EBTB were diagnosed over a period of 6 months with varying outcomes. Symptoms were variable: dry cough, low grade fever, weakness, chest pain and progressive dyspnoea. Sputum analysis was negative for Mycobacterium. EBTB was diagnosed on histopathology samples obtained via bronchoscopic(FOB) biopsy. Observation: The patients were all females, 5 aged below 30 years. FOB showed overgrowth of granulation tissue, of varying severity, leading to partial to complete occlusion of the affected left main bronchus, resulting in recurrent lobar or complete lung collapse in spite of adequate anti tubercular drugs(ATDs). Lung could be salvaged in 3 patients by early diagnosis and application of various modalities like balloon dilatation, mucosal incisions and stents, while 2 patients required pneumonectomy. 1 patient was an elderly female who presented with stridor, had tracheal stenosis on FOB and responded to tracheal stent and ATDs. Conclusion: EBTB was found to mainly affect young females and left main bronchus is commonly involved. Identification of this phenotype of TB and early application of bronchoscopy in diagnosis and management of EBTB can prevent significant debilitation or lung tissue loss. High index of suspicion is necessary for EBTB when making the diagnosis in sputum negative patients. Multi centre collaborations to look at various outcomes in EBTB patients and novel lung salvaging therapies shall be beneficial in future.