Acute Endobronchial Dissemination of a Tuberculoma Following EBUS ‐ GS ‐Guided Transbronchial Biopsy: A Case Report

Post‐bronchoscopy infections are usually bacterial, whereas procedure‐associated endobronchial dissemination of Mycobacterium tuberculosis is rarely reported. A 52‐year‐old woman with poorly controlled diabetes (HbA1c 13.8%) had a 19‐mm left upper‐lobe nodule radiologically suspicious for lung cancer. Because tissue confirmation was required and tuberculosis remained in the differential diagnosis (positive T‐SPOT.TB on admission), endobronchial ultrasonography with a guide sheath (EBUS‐GS)‐guided transbronchial biopsy was performed under airborne precautions. Bronchial lavage smear and loop‐mediated isothermal amplification were positive for M. tuberculosis , and histology showed extensive caseous necrosis with numerous acid‐fast bacilli, consistent with a tuberculoma. Two days later, she developed a 39°C fever with rapid cavitation of the primary lesion and new ipsilateral tree‐in‐bud opacities. No bacterial pathogens other than M. tuberculosis were identified despite empirical ceftriaxone. Standard antituberculosis therapy led to clinical and radiological improvement.