Tuberculosis-induced cartilage fractures leading to collapse of the left main stem bronchus

Correspondence to Dr Rocco Trisolini, Interventional Pulmonology Unit, Policlinico S. Orsola-Malpighi, Bologna 40138, Italy; rocco.trisolini@aosp.bo.it Case presentation A 94-year-old female patient was referred to the emergency department of our hospital for cough productive of purulent sputum and recurrent episodes of haemoptysis. Follow-up CT, performed after antituberculous treatment, shows a marked reduction of the consolidation of the upper lobe (D,E) as well as of the number and size of centrilobular nodules of the lower lobe (D,E), but demonstrates also an increase in the number of damaged cartilage rings, which extend up to the lobar bronchi (F, arrows). Rupture and protrusion of the airway cartilage rings, also known as fish-scale airway degeneration, is an exceedingly rare and poorly known complication of pulmonary tuberculosis.1 2 The case presented herein is the third microbiologically confirmed case published in the medical literature, to our knowledge.1 2 Interestingly, all of the patients described up to now were female, and all of them underwent resolution of the clinical and microbiological abnormalities, but the anti-TB treatment had no effect whatsoever on the airway cartilage damage.1 2 Contributors RT contributed to the conception and design, as well as writing of the manuscript.