open access

Vol 83, No 5 (2015)
CASE REPORTS
Submitted: 2015-09-08
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Middle lobe syndrome: an extraordinary presentation of endobronchial tuberculosis

Tinu Garg, Kamal Gera, Ashok Shah
DOI: 10.5603/PiAP.2015.0062
·
Pneumonol Alergol Pol 2015;83(5):387-391.

open access

Vol 83, No 5 (2015)
CASE REPORTS
Submitted: 2015-09-08

Abstract

Tuberculous infection of the tracheobronchial tree, termed as endobronchial tuberculosis (EBTB), is more common in young adults and females. This clinical entity is poorly understood and the diagnosis is frequently delayed as sputum smears are often negative for acid fast bacilli and the chest radiograph can be normal, resulting in diagnostic confusion. Bronchoscopy continues to play a key role in its diagnosis. Though atelectasis is not uncommon in these patients, EBTB presenting as a middle lobe syndrome (MLS) has rarely been documented. MLS refers to chronic or recurrent collapse of the right middle lobe and has a myriad of causes. The pathogenesis of this entity too is not fully established. We report this exceptional clinical manifestation in a 19-year-old male, who presented for evaluation of respiratory symptoms for 6 months along with constitutional complaints. Imaging suggested the presence of MLS and bronchoscopy established the diagnosis of endobronchial tuberculosis. GeneXpert evaluation of bronchial aspirate detected Mycobacterium tuberculosis. Histopathology confirmed the presence of granulomatous lesions. Subsequently, the cultures of bronchial aspirate and post-bronchoscopy sputum grew M. tuberculosis. Appropriate therapy with anti-tuberculosis drugs resulted in a remarkable symptomatic and radiological improvement. EBTB presenting as a MLS is a distinct rarity.

Abstract

Tuberculous infection of the tracheobronchial tree, termed as endobronchial tuberculosis (EBTB), is more common in young adults and females. This clinical entity is poorly understood and the diagnosis is frequently delayed as sputum smears are often negative for acid fast bacilli and the chest radiograph can be normal, resulting in diagnostic confusion. Bronchoscopy continues to play a key role in its diagnosis. Though atelectasis is not uncommon in these patients, EBTB presenting as a middle lobe syndrome (MLS) has rarely been documented. MLS refers to chronic or recurrent collapse of the right middle lobe and has a myriad of causes. The pathogenesis of this entity too is not fully established. We report this exceptional clinical manifestation in a 19-year-old male, who presented for evaluation of respiratory symptoms for 6 months along with constitutional complaints. Imaging suggested the presence of MLS and bronchoscopy established the diagnosis of endobronchial tuberculosis. GeneXpert evaluation of bronchial aspirate detected Mycobacterium tuberculosis. Histopathology confirmed the presence of granulomatous lesions. Subsequently, the cultures of bronchial aspirate and post-bronchoscopy sputum grew M. tuberculosis. Appropriate therapy with anti-tuberculosis drugs resulted in a remarkable symptomatic and radiological improvement. EBTB presenting as a MLS is a distinct rarity.

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Keywords

chest imaging, endobronchial tuberculosis, fibreoptic bronchoscopy, middle lobe syndrome, Mycobacterium tuberculosis

About this article
Title

Middle lobe syndrome: an extraordinary presentation of endobronchial tuberculosis

Journal

Advances in Respiratory Medicine

Issue

Vol 83, No 5 (2015)

Pages

387-391

DOI

10.5603/PiAP.2015.0062

Bibliographic record

Pneumonol Alergol Pol 2015;83(5):387-391.

Keywords

chest imaging
endobronchial tuberculosis
fibreoptic bronchoscopy
middle lobe syndrome
Mycobacterium tuberculosis

Authors

Tinu Garg
Kamal Gera
Ashok Shah

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