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24 April 2015 : Case report  Italy

Unusual Clinical Presentation of Thoracic Tuberculosis: The Need for a Better Knowledge of Illness

Unusual clinical course, Mistake in diagnosis, Diagnostic / therapeutic accidents, Educational Purpose (only if useful for a systematic review or synthesis)

Sandra MancaBCDEF, Alessandro Giuseppe FoisBCDF, Luigi SantoruBCD, Rocco TrisoliniBCD, Maria Francesca PoloBCD, Salvatore OsteraBCD, Marco PatelliBCD, Pietro PirinaABCDEF

DOI: 10.12659/AJCR.892546

Am J Case Rep 2015; 16:240-244

Abstract

BACKGROUND: Pulmonary tuberculosis (TB), a highly contagious infectious disease, is a significant public health problem all over the world and remains an important cause of preventable death in the adult population. Endobronchial TB is an unusual form of thoracic TB that may be complicated by tracheobronchial stenosis, and bronchoesophageal fistula formation is a very rare complication. Tubercular lymphadenitis can also lead to fistula formation through a process of caseum necrosis and opening of a fistula between the bronchus and oesophagus.

CASE REPORT: We report an uncommon case of thoracic TB in an immunocompetent 73-year-old Caucasian man who presented several problems: bronchoesophageal fistula, endobronchial TB, and mediastinal lymphadenopathy in the absence of contemporary parenchymal consolidation. Furthermore, he presented a normal chest radiograph and mostly unclear and non-specific symptoms at onset.

CONCLUSIONS: We emphasize the need for a better knowledge of this illness and awareness that it may have an unusual presentation. In these cases, diagnosis and proper treatment can be delayed, with severe complications for the patient. Pulmonary TB remains a real diagnostic challenge: a normal chest radiograph and nonspecific symptoms do not allow us to exclude this persistent infectious disease.

Keywords: Bronchial Fistula - etiology, Bronchoscopy, Diagnosis, Differential, Mediastinitis - microbiology, Mycobacterium tuberculosis - isolation & purification, Radiography, Thoracic, Tomography, X-Ray Computed, Tuberculosis, Lymph Node - diagnosis

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923