ENDOBRONCHIAL TUBERCULOSIS PRESENTING AS OBSTRUCTIVE BRONCHIAL TUMOR IN AN HIV-1 POSITIVE PATIENT, CASE-REPORT AND LITERATURE-REVIEW

Introduction. -A rare case report of endobronchial tuberculosis is rep orted in an HIV-1 positive patient of black African origin. Exegesis. -A 38-year-old woman of Guinean origin, HIV-1 positive, presented with persistent right upper lobe opacity at chest X-ray. Computerized tomo graphy of the chest after injection confirmed this finding and reveale d right laterotracheal and Barety space adenopathy. Investigations of acid-fast bacilli in the biological media were negative. Fiberoptic br onchoscopy showed endobronchial lesion on rite wall of the ventral par t of the right upper lobe, which had the appearance of bronchogenic ca rcinoma, and infiltrates in the dorsal mucosa. Biopsy of the lesion re vealed granuloma formation, but no evidence of caseation necrosis. Ide ntification of Mycobacterium tuberculosis in sputum culture helped arr ive at a diagnosis of endobronchial tuberculosis similar to obstructiv e bronchial turner. Conclusion. -This case of endobronchial tuberculos is is the first described in an HIV-1 positive patient of black Africa n origin. Mediastinal lymph node revealed by chest computerized tomogr aphy 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 fibroscop y permitted the exclusion of endobronchial neoplasia. In addition, the sensitivity of direct microscopy for acid-fast bacilli is poor. Ident ification of Mycobacterium tuberculosis by sputum culture helped guide the diagnosis which was further confirmed by a good therapeutic respo nse. This case of endobronchial tuberculosis in an immunodepressed pat ient underlines the difficulty in determining the etiology of pulmonar y opacities. (C) 1998, Elsevier, Paris.