01 Feb

Endobronchial Tuberculosis in the Acquired Immunodeficiency Syndrome: Conclusion

In addition, tuberculosis appears to be significantly easier to diagnose by endobronchial biopsy than Kaposi’s sarcoma.* Another endobronchial process to consider in a patient with AIDS is P carinii pneumonia. There is a recent report of a patient with a cavitary lingular infiltrate who, at the time of bronchoscopy, had a mass very similar to those described herein obstructing the lingular orifice. Biopsy revealed only P carinii pneumonia; however, two months prior to that, sputum and percutaneous needle aspiration of the left lung had grown M tuberculosis, and the patient was receiving chemotherapy. This information is difficult to interpret, and the lesion may very well have represented endobronchial tuberculosis in addition to P carinii pneumonia.

Even in the normal host, the propensity for endobronchial tuberculosis to mimic bronchogenic carcinoma and bacterial and fungal infections often delays the diagnosis;- however, in most instances, the delay in receiving proper therapy has no deleterious effects. In contrast to this, the cases of AIDS reported herein had rapid progression of the radiographic findings and deterioration in the clinical status prior to the institution of antituberculosis chemotherapy. Patient 1 developed a postobstructive pneumonia, patient 2 developed an enlarging anterior mediastinal mass, and patient 3 had marked respiratory distress with evidence of lymphohematogenous dissemination on the chest x-ray film and blood cultures positive for M tuberculosis. The presence of depressed cell-mediated immunity in these patients is most likely responsible for the more severe clinical course. Despite this, all three patients had the fever abate within two weeks from the start of chemotherapy, and marked roentgen-ographic resolution occurred by the time of discharge.
As is often the case with the normal host, endobronchial tuberculosis in a patient with AIDS can be a diagnostic enigma. Therefore, once this characteristic endobronchial lesion is identified in a patient with AIDS or ARC, the bronchial washings should be examined rapidly for acid-fast bacilli so as to avoid a delay in diagnosis and resultant increased morbidity and mortality.

Categories: Tuberculosis
Tags: , , , ,

© 2008 HIV/AIDS News & Information