A Case of Endobronchial Tuberculosis with Repeated Expectoration of Nodular Tissues

반복적인 결절조직 배출 후 호전된 기관지 결핵 1예

  • Kim, Soo Woong (Dept. of Internal Medicine, Eulji Hospital, Eulji University School of Medicine) ;
  • Lee, Byoung Hoon (Dept. of Internal Medicine, Eulji Hospital, Eulji University School of Medicine) ;
  • Ahn, Youngsoo (Dept. of Internal Medicine, Eulji Hospital, Eulji University School of Medicine) ;
  • Kim, Nam In (Dept. of Internal Medicine, Eulji Hospital, Eulji University School of Medicine) ;
  • Eom, Woo Youn (Dept. of Internal Medicine, Eulji Hospital, Eulji University School of Medicine) ;
  • Woo, Jeong Joo (Dept. of Radiology, Eulji Hospital, Eulji University School of Medicine) ;
  • Kim, Sang-Hoon (Dept. of Internal Medicine, Eulji Hospital, Eulji University School of Medicine)
  • 김수웅 (을지의대 을지병원 내과) ;
  • 이병훈 (을지의대 을지병원 내과) ;
  • 안영수 (을지의대 을지병원 내과) ;
  • 김남인 (을지의대 을지병원 내과) ;
  • 엄우연 (을지의대 을지병원 내과) ;
  • 우정주 (을지의대 을지병원 방사선과) ;
  • 김상훈 (을지의대 을지병원 내과)
  • Received : 2005.04.14
  • Accepted : 2005.07.26
  • Published : 2005.08.30

Abstract

Herein, we report a case of tumorous endobronchial tuberculosis with successful recovery of atelectasis without any significant bronchial stricture, after repeated expectorations of nodular tissues. A 24-year-old male patient was presented with persistent cough. The patient was diagnosed to be suffering from tuberculous lymphadenitis on right axillar and mediastinum of lung, and was subsequently treated with antituberculosis agents. After two months, clinical deteriorations and atelectasis were observed on right upper lobe of lung. Multiple endobronchial tumorous lesions, which obstructed the right main bronchus, were revealed on bronchoscopy, and based on the endobronchial biopsy findings we confirmed that the patient was suffering from endobronchial tuberculosis. We decided to administer antituberculosis agents without any additional procedure. After few weeks, the patient spontaneously expectorated nodular tissues with vigorous coughing. Later on, the symptoms and atelectasis disappeared and the patient was completely recovered. This case shows that in patients suffering from tumorous endobronchial tuberculosis, endobronchial mass can be expectorated spontaneously without sequelae of significant bronchial stenosis.

기관지 결핵은 치료 기간이 길고 후유증이 나타날 수 있어 적극적인 치료와 세심한 추적관찰을 요하는 질환이다. 저자들은 항결핵 화학요법 중 무기폐가 진행되었다가 특별한 시술 없이 물리치료와 체위배농만으로 결절 조직이 자연 배출된 후 임상 증상 및 방사선 소견이 호전된 기관지 결핵 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

Keywords

References

  1. Park EJ, Kim MO, Yang SC, Sohn JW, Yoon HJ, Shin DH, et al. Clinical and bronchoscopic features of 280 patients with endobronchial tuberculosis (1990-2001). Korean J Med 2003;64:284-92
  2. Chung HS, Lee JH. Bronchoscopic assessment of the evolution of endobronchial tuberculosis. Chest 2000;117:385-92 https://doi.org/10.1378/chest.117.2.385
  3. Kurasawa T, Kuze F, Kawai M, Amitani R, Murayama T, Tanaka E, et al. Diagnosis and management of endobronchial tuberculosis. Intern Med 1992;31:593-8 https://doi.org/10.2169/internalmedicine.31.593
  4. Hoheisel G, Chan BK, Chan CH, Chan KS, Teschler H, Costabel U. Endobronchial tuberculosis: diagnostic features and therapeutic outcome. Respir Med 1994;88:593-7 https://doi.org/10.1016/S0954-6111(05)80007-1
  5. Smith LS, Schillai RF, Sarlin RF. Endobronchial tuberculosis: serial fiberoptic bronchoscopy and natural history. Chest 1987;91:644-7 https://doi.org/10.1378/chest.91.5.644
  6. Shulutko ML, Kazak TI, Tarasov AS. Chapter9. Tuberculosis. In: Lukomsky GI, editor. Bronchology. 1st ed. St Louis: CV Mosby; 1979. p.287
  7. Ahn CM, Kim HJ, Hwang ES, Kim SK, Lee WY, Kim SJ. A clinical study on 61 cases of tuberculous tracheobronchitis. Tuberc Respir Dis 1991;38;340-6
  8. Lee JH, Park SS, Lee DH, Shin DH, Yang SC, Yoo BM. Endobronchial tuberculosis: clinical and bronchoscopic features in 121 cases. Chest 1992;102:990-4 https://doi.org/10.1378/chest.102.4.990
  9. Judd AR. Tuberculous tracheobronchitis. J Thoracic Surg 1947;16:512-23
  10. Chung HS, Hyun IG, Han SK. Bronchoscopic electrocautery for airway obstruction in the tumorous type of endobronchial tuberculosis. Tuberc Respir Dis 1991;38:347-56
  11. Choi YW, Kim YS, Jeon SC, Hahm CK, Choi CS. Treatment of tracheobronchial stenosis with a self-expandable metallic stents. J Korean Radiol Soc 1994;31:35-41 https://doi.org/10.3348/jkrs.1994.31.1.35
  12. Caligiuri PA, Banner AS, Jensik RJ. Tuberculous main-stem bronchial stensosis treated with sleeve resection. Arch Intern Med 1984;144:1302-3 https://doi.org/10.1001/archinte.144.6.1302
  13. Mo EK, Kim HJ, Choi JE, Kim DG, Park MJ, Hyun IG, et al. The effect of corticosteroid on the treatment of endobronchial tuberculosis. Tuberc Respir Dis 1997;44:409-18 https://doi.org/10.4046/trd.1997.44.2.409
  14. Park IW, Choi BW, Hue SH. Prospective study of corticosteroid as an adjunct in the treatment of endobronchial tuberculosis in adults. Respirology 1997;2:275-81 https://doi.org/10.1111/j.1440-1843.1997.tb00089.x