Background: When left untreated tuberculosis has the potential to cause significant morbidity and mortality. In many instances adequate microbiologic therapy does not exclude chronic respiratory complications. Bronchostenosis is an under recognized complication with potentially far reaching complications.
Methods: Patients with evidence of bronchial stenosis and lung volume loss who were previously treated with pulmonary tuberculosis were included in our retrospective review. Patients were all found to be IGRA or TST positive with no microbiologic evidence of active infection. All patients had no evidence of immunosuppression. .
Results: Four patients qualified for our case series. This included 2 males and 2 females. Ages ranged from 24 to 75. All patients reported completing treatment for pulmonary tuberculosis. None of the patients had microbiologic or radiologic evidence of active pulmonary tuberculosis. 3 patients noted chronic respiratory symptoms without any other identifiable etiology. 2 patients demonstrated bronchoscopic evidence of stenosis. 4 patients had radiologic evidence of lung volume loss with hyperinflation of contralateral lung. One patient had symptomatic improvement after bronchoscopic dilation. One patient developed multiple recurrent infections distal to the stenosis. One patient developed pulmonary hypertension with evidence of cor pulmonale
Conclusions: Bronchostenosis is a recognized complication of tuberculosis, which occurs despite appropriate microbiologic therapy. Bronchostenosis is a frequent consequence of endobronchial tuberculosis which is observed in greater than a third of pulmonary tuberculosis case. Clinicians should consider the possibility of residual ventilatory impairment after treatment of pulmonary tuberculosis. If clincial scenario warrants, bronchoscopic surveillance may be required for identification and management of fibrotic changes. Further study is needed to ascertain the benefit of corticosteroids and extended RIPE therapy. Asymptomatic patients may be followed clinically. Symptomatic patient may require bronchoscopic intervention.