Infect Chemother.  2012 Feb;44(1):35-39. 10.3947/ic.2012.44.1.35.

Lymphobronchial Fistula of Tuberculous Lymphadenitis in Acquired Immunodeficiency Syndrome

• Yoon JH
• Jung JY
• Min JW
• Park SY
• Jeon YD
• Hong HC
• Bang JH
• Joh JS

• KMID: 1782397
• DOI: http://doi.org/10.3947/ic.2012.44.1.35

Abstract

Bronchial invasion of tuberculous lymphadenitis in children has been reported in areas of high tuberculosis (TB) prevalence as a complication due to primary pulmonary tuberculosis. However, it is rare in immunocompetent adults. When it appears, it often presents as a consequence of the reactivation of TB in the lung parenchyma. Primary TB occurs more frequently in patients with human immunodeficiency virus (HIV), with a history of organ transplants, or undergoing immunosuppressive treatments such as steroids. Furthermore, bronchial invasion of the bronchus by tuberculous lymphadenitis is considered to be very rare even among immunocompromised adults with primary TB, and has never before been reported in Korea. The authors report a case of bronchial invasion of the bronchus by tuberculous lymphadenitis, confirmed by bronchoscopy, in an Acquired Immunodeficiency Syndrome (AIDS) patient.

Keyword

Tuberculosis; Lymph node; Fistula; HIV

MeSH Terms

Acquired Immunodeficiency Syndrome
Adult
Bronchi
Bronchoscopy
Child
Fistula
HIV
Humans
Korea
Lung
Lymph Nodes
Prevalence
Steroids
Transplants
Tuberculosis
Tuberculosis, Lymph Node
Tuberculosis, Pulmonary
Steroids

Figure

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  Figure 1 Chest radiography shows mediastinal widening and right hilar bulging without parenchymal infiltration on admission.

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  Figure 2 Chest CT scan shows the enlargement of peribronchial lymph node in the right middle lobe bronchus.

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  Figure 3 Bronchoscopic findings: (A) Right middle lobe bronchus is filled with white caseous material, which is in agreement with the soft tissue abnormality seen on the chest CT. (B) A fistula was discovered after the removal of the white caseous material. (C) A fistula and white node-like spots are shown on the left main bronchus. These bronchoscopic findings suggested the infiltration of the TB lymphadenitis into the bronchus.

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  Figure 4 Histopathologic finding of bronchoscopic biopsy: (A) Caseous necrosis and lymphocyte infiltration (H&E stain, ×400). (B) Positive acid fast bacilli (AFB) are present (AFB stain, ×1,000).

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  Figure 5 Contrast-enhanced brain CT. A mass with edema was shown on the left frontal area surrounded by a hyperdense lesion.

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  Figure 6 T1 weighted brain MRI shows multiple enhanced lesions.

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