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Kang, Lee, Park, and Shim: A Case of Delayed Response of Tumorous type of Endobronchial Tuberculosis to Antituberculosis Treatment
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2006; 60(3): 342-346.

Published online: 31 March 2006

DOI: https://doi.org/10.4046/trd.2006.60.3.342

A Case of Delayed Response of Tumorous type of Endobronchial Tuberculosis to Antituberculosis Treatment

Ho-Suck Kang, M.D., Kwang Ha Lee, M.D., I-Nae Park, M.D., Tae Sun Shim, M.D.

Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Address for correspondence: Tae Sun Shim, M.D., Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea. Phone: 02-3010-3892, Fax: 02-3010-6968, shimts@amc.seoul.kr

Received 6 February 2006       Accepted 14 March 2006

Copyright © 2006 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

Pulmonary tuberculomas show variable responses to treatment, with some even increasing in size after treatment. To date, however, no data have been reported on the response of tumorous type of endobronchial tuberculosis (EBTB-T) to treatment observed both bronchoscopically and histologically. We report a case of bacteriologically- and biopsy-proven EBTB-T that showed delayed response to anti-tuberculosis treatment. Even after EBTB-T was treated with antituberculosis drugs for 15 months, the bronchoscopic findings and the histologic findings of chronic granulomatous inflammation with caseation necrosis still remained. However, in fourteen months after the completion of treatment, the lesioneventually disappeared without further treatment.

Keywords: Endobronchial tuberculosis, Tumorous type, Delayed response

Figures and Tables

Figure 1
Chest radiographic findings
A. Baseline chest radiography before treatment shows multifocal patchy air-space consolidation and multiple small nodular densities along bronchovascular bundle with subsegmental atelectasis in the left upper lobe.
B. Chest radiography at treatment completion shows decreased extent of ill-defined nodular opacity and persistent fibrotic change with subsegmental atelectasis in the left upper lobe.
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Figure 2
Bronchoscopic findings
A. Baseline. A smooth-surfaced endobronchial mass obstructing anterior segmental bronchus of upper division of left upper lobe was seen.
B. At treatment completion. A flesh-like soft tissue mass covered with whitish necrotic material was persistent at the same site with slightly decreased size.
C. Fourteen months later after treatment completion. The mass disappeared and the anterior segmental bronchus of upper division of left upper lobe was patent with minimal fibrotic changes.
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Figure 3
Microscopic findings (× 400)
Baseline. Chronic granulomatous inflammation (TB PCR - positive)
B. At treatment completion. Chronic granulomatous inflammation with caseating necrosis ( AFB - positive ).
trd-60-342-g003

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