Abstract Introduction Endobronchial tuberculosis (EBTB) is an uncommon manifestation of Mycobacterium tuberculosis infection involving the tracheobronchial tree. Its non-specific clinical and imaging features can mimic malignancy, complicating diagnosis in patients with underlying cancer. Bronchoscopy provides direct visualization and sampling for diagnostic confirmation. We report a 45-year-old woman with newly diagnosed cervical cancer and chronic cough, ultimately diagnosed with EBTB, highlighting the importance of considering this entity in oncologic patients with unexplained respiratory symptoms. Case A 45-year-old woman with newly diagnosed cervical squamous cell carcinoma and suspected lung metastases presented with 4 days of fever, headaches, productive cough, dyspnea, and myalgias. She had a two-month history of chronic cough unresponsive to a course of antibiotics. Prior imaging revealed the known cervical mass, left hilar adenopathy, and multiple left upper lobe nodules. PET-CT demonstrated a hypermetabolic cervical lesion with pelvic adenopathy, left upper lobe consolidation with adjacent mediastinal left hilar and axillary lymphadenopathy. She was awaiting oncologic treatment initiation. A former smoker from Honduras with remote tuberculosis exposure, she immigrated to the US eight years prior. On presentation, she was febrile, tachycardic, and normoxic. Laboratory studies were unrevealing. Empiric antibiotics were broadened for worsening bilateral consolidations and lymphadenopathy. Fiberoptic bronchoscopy revealed mucosal thickening with 50% narrowing of the left mainstem bronchus extending into the left upper and lower lobes, with inaccessible subsegments due to 50% narrowing. Endobronchial biopsies showed caseating granulomatous inflammation without malignancy. Sputum PCR and cultures confirmed pan-sensitive/RIF resistance-negative Mycobacterium tuberculosis, consistent with granular/fibro-stenotic EBTB. No further interventions were required; she was started on RIPE therapy with resolution of fever and cough within two months. Follow-up bronchoscopy at three months showed no malignancy or persistent infection on histopathology. She completed nine months of therapy with full recovery. Discussion EBTB affects approximately 10-50% of patients with tuberculosis. Risk factors include female sex, age 50, persistent symptoms, urban residence, and no prior tuberculosis. Clinical and imaging findings - airway narrowing/obstruction, wall thickening, or lymphadenopathy - are non-specific and can mimic metastatic disease in cancer patients. Bronchoscopy with the Chung and Lee classification (caseating, edematous-hyperemic, fibro-stenotic, tumorous, ulcerative, granular, and non-specific) guides diagnosis, advanced interventions, prognosis, and management with therapy tailored based on AFB smear, NAAT, and drug susceptibility testing. Conclusion This case highlights the challenge of distinguishing tuberculosis from metastatic disease in cancer patients. The importance of a high index of suspicion with tissue and culture confirmation in atypical or progressive pulmonary lesions. This abstract is funded by: None
Camacho et al. (Fri,) studied this question.