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A 5-month-old infant of Zimbabwean origin presented with cough, fever, night sweats and decreased appetite of 2 weeks’ duration. The Mantoux test was positive (8 mm) and early morning gastric aspirates grew fully sensitive Mycobacterium tuberculosis. Chest x ray showed right upper and middle lobe collapse with consolidation. The family had been living in the UK for 2 years. There was a positive family history of tuberculosis (TB), with the child’s mother and cousin undergoing treatment. HIV status was negative. The child was treated with oral steroids and quadruple therapy for TB.
Although most of his symptoms improved on treatment, the infant continued to be intermittently wheezy, predominantly on the right. Despite 10 weeks of anti-TB chemotherapy, radiological changes persisted (fig 1). Flexible bronchoscopy revealed a yellow coloured endobronchial polyp extruding from the right upper lobe bronchus into the right main bronchus (fig 2). The polyp was excised by rigid bronchoscopy and on histological examination inflammatory tissue with dystrophic calcification and background granulomatous inflammation was seen. The bronchial mucosa showed focal surface ulceration and granulation tissue formation. A single bacillus was seen on Ziehl-Neelsen stain.
Early detection and effective treatment of endobronchial TB is important in order to decrease secondary complications, including bronchial stenosis and bronchiectasis. Steroid therapy in conjunction with appropriate anti-tuberculous chemotherapy has been reported to be effective in the treatment of endobronchial TB.1 2
The most accurate way of diagnosing an endobronchial polyp is by flexible bronchoscopy. Therefore, early bronchoscopy is advised in children with suspected endobronchial TB because of airway compression or persistent collapse of the distal lung parenchyma.3
Competing interests: None.
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