Title : Endobronchial tuberculosis causing central airway obstruction with concomitant tuberculous pericarditis and allergic bronchopulmonary aspergillosis in pregnancy: A case report
Abstract:
Background: Endobronchial tuberculosis (EBTB) is an uncommon manifestation of pulmonary tuberculosis that can result in life-threatening central airway obstruction. The combination of EBTB, tuberculous pericarditis, and allergic bronchopulmonary aspergillosis (ABPA) is exceptionally rare and poses significant diagnostic and therapeutic challenges. Pregnancy further complicates management because of maternal–fetal considerations and limited treatment options.
Case Presentation: A 28-year-old HIV-negative Filipino female with bacteriologically confirmed pulmonary tuberculosis presented in her third month of treatment with worsening dyspnea and hemoptysis after a one-year history of productive cough. Imaging revealed complete right lung atelectasis with pleural effusion, and bronchoscopy showed near-total right main bronchus obstruction by granulation tissue, initially suspected to be malignant. Bronchoscopic debulking restored airway patency, but acute hypoxemic respiratory failure necessitated prolonged mechanical ventilation. Positive Bronchoalveolar Lavage (BAL) and serum galactomannan supported concomitant allergic bronchopulmonary aspergillosis, with marked improvement following Hydrocortisone and Voriconazole. Voriconazole was discontinued after incidental detection of a viable 12-week pregnancy, while corticosteroids and antibiotics were continued for bacterial pneumonia. Although disseminated multidrug-resistant tuberculosis was initially suspected because of tuberculous pericarditis and indeterminate rifampicin resistance on BAL Mycobacterium tuberculosis PCR, repeat sputum MTB PCR confirmed rifampicin-susceptible tuberculosis. Treatment with Isoniazid and Rifampicin was continued, leading to recovery and hospital discharge.
Discussion: Delayed recognition of pulmonary tuberculosis likely allowed progression to endobronchial disease and hematogenous dissemination, resulting in central airway obstruction and tuberculous pericarditis. Bronchial injury impaired mucociliary clearance, facilitating Aspergillus fumigatus colonization, while pregnancy-related immune changes may have promoted disseminated tuberculosis and the development of ABPA. This case highlights the rare coexistence of Endobronchial Tuberculosis (EBTB) and ABPA and underscores the importance of early bronchoscopy, microbiologic confirmation, and multidisciplinary management in patients with persistent respiratory symptoms or unexplained airway obstruction, particularly in disseminated tuberculosis during pregnancy
