Respir Case Rep. 2014; 3(1): 36-40 | DOI: 10.5505/respircase.2014.39974

A case of endobronchial tuberculosis developed under anti-TNF-alpha treatment

Serdar Berk, Tekmile Aysu Odabaþý, Ömer Tamer Doðan, Sefa Levent Özþahin
Cumhuriyet University Faculty Of Medicine, Department Of Chest Diseases

Endobronchial tuberculosis (EBTB) is defined as inflammation of the bronchial tree with M. tuberculosis, and rarely seen in adults. Differential diagnosis includes asthma, foreign body aspiration, and bronchial cancer. Anti-TNF-alpha agents have been increasingly used in patients with rheumatoid arthritis (RA). Tuberculosis is the most dangerous complication of this treatment. Endobronchial tuberculosis developed under anti-TNF-alpha treatment was presented in this paper. A 53-year-old woman under anti-TNF-alpha treatment for four years because of RA was admitted with signs and symptoms of pneumonia, which did not improve with antibiotic therapy. Non-homogeneous infiltration with irregular margins of the left upper zone was seen on chest X-ray and computed tomography. Sputum-smear microscopy for acid-fast bacilli was negative in two samples. Endobronchial nodular plaques were seen on bronchoscopy. Acid-fast bacilli were positive in the bronchial lavage fluid. Culture for M. tuberculosis and cytological examination confirmed the diagnosis and anti-TB treatment was initiated.

Keywords: Endobronchial tuberculosis, bronchoscophy, anti-TNF-alpha

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Anti-TNF-Alfa Tedavisi Sýrasýnda Geliþen Endobronþiyal Tüberküloz Olgusu

Serdar Berk, Tekmile Aysu Odabaþý, Ömer Tamer Doðan, Sefa Levent Özþahin
Cumhuriyet Üniversitesi Týp Fakültesi, Göðüs Hastalýklarý Ana Bilim Dalý

Endobronþiyal tüberküloz (EBTB), trakeobronþiyal aðacýn M. tuberculosis ile enfeksiyonu olarak tanýmlanýr. Eriþkinlerde nadir görülür. Astým, yabancý cisim aspirasyonu ve bronþ kanseri ile karýþabilmektedir. Tümör nekroz faktör (TNF) alfa blokerlerin romatoid artrit (RA) tedavisinde kullanýmý giderek artmaktadýr. Bu tedavinin en önemli yan etkilerinden birisi de tüberküloz enfeksiyonuna yatkýnlýk oluþturmasýdýr. Bu yazýda anti TNF-alfa tedavisi esnasýnda EBTB geliþen bir olgu sunulmuþtur. Son 4 yýldýr RA nedeniyle anti TNF-alfa tedavisi alan 53 yaþýnda kadýn hasta antibiyotik tedavisine raðmen düzelmeyen pnömoni bulgularý ile baþvurdu. Akciðer grafisinde sol üst zonda non-homojen infiltrasyon mevcuttu. Ýki kez balgam asidorezistan basil (ARB) incelemesi menfi bulundu. Toraks BT’ de sol akciðer üst lobda düzensiz sýnýrlý konsolidasyon, bronkoskopik incelemesinde sol üst lobda nodüler plaklar izlendi. Buradan yapýlan bronþ lavajýnda ARB müspet bulundu. Kültür ve sitolojik olarak da TB tanýsý desteklenen hasta EBTB tanýsý ile tedaviye alýndý.

Anahtar Kelimeler: Endobronþiyal tüberküloz, bronkoskopi, anti TNF-alfa

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