Endobronchial tuberculosis presenting as an obstructive tumor in an HIV-1-positive patient. Apropos of a case and review of the literature

A rare case report of endobronchial tuberculosis is reported in an HIV-1 positive patient of black African origin. A 38-year-old woman of Guinean origin, HIV-1 positive, presented with persistent right upper lobe opacity at chest X-ray. Computerized tomography of the chest after injection confirmed this finding and revealed right laterotracheal and Barety space adenopathy. Investigations of acid-fast bacilli in the biological media were negative. Fiberoptic bronchoscopy showed endobronchial lesion on the wall of the ventral part of the right upper lobe, which had the appearance of bronchogenic carcinoma, and infiltrates in the dorsal mucosa. Biopsy of the lesion revealed granuloma formation, but no evidence of caseation necrosis. Identification of Mycobacterium tuberculosis in sputum culture helped arrive at a diagnosis of endobronchial tuberculosis similar to obstructive bronchial tumor. This case of endobronchial tuberculosis is the first described in an HIV-1 positive patient of black African origin. Mediastinal lymph node revealed by chest computerized tomography after injection could be the site of spreading of mycobacteria by fistulization of tuberculosis lymph node into the right main bronchus. Only the histology of lesions carried out during bronchial fibroscopy permitted the exclusion of endobronchial neoplasia. In addition, the sensitivity of direct microscopy for acid-fast bacilli is poor. Identification of Mycobacterium tuberculosis by sputum culture helped guide the diagnosis which was further confirmed by a good therapeutic response. This case of endobronchial tuberculosis in an immunodepressed patient underlines the difficulty in determining the etiology of pulmonary opacities.