Endobronchial Tuberculous Granuloma in Children

Abstract

Endobronchial tuberculosis is rare in children, in whom it is usually a complication of primary tuberculosis. Endobronchial involvement may adopt several forms, with granuloma being infrequent. Here we report on 10 cases of endobronchial tuberculous granuloma diagnosed and treated in our Paediatric Surgery Service between 1991 and 2004. In 2 cases the presentation was acute and constituted the first manifestation of TB; the remaining patients were undergoing treatment or had been treated for primary TB, and presented with clinical symptoms or radiological signs that led us to suspect endobronchial involvement. In all cases the granuloma was removed by bronchoscopy. Patients received conventional medical TB treatment, with corticoids for 4 weeks following granuloma removal. The clinical course was favourable in all cases and on follow-up we saw no complications. Endobronchial tuberculous granuloma should be borne in mind in children with symptoms or signs of airway obstruction and especially during the course of tuberculosis treatment.

Endobronchial tuberculosis in children: Defining the role of interventional bronchoscopy

“…However, the quality of evidence was very low, there was no standard dose schedule, and the trials were conducted in the 60s−90s 7 . We do agree with other authors that an immunemediated mechanism has a role in EBTB pathogenesis, and the corticosteroid anti‐inflammatory action may have beneficial effects 12,17 . In our series we used prednisolone (1−2 mg/kg/day) for at least a month in all patients, without any systemic side effects.…”

“…EBTB pathogenesis is not well understood, and diverse theories have been proposed: lymphatic or hematogenous dissemination, endobronchial implantation from infected sputum or adjacent parenchyma, and lymph node erosion into the bronchus 4,11 . This last mechanism seems to play an important role in pediatric EBTB 4,12,13 . In fact, we report two cases of complete endobronchial obstruction with caseous/mucoid material with an extremely high tendency to recurrence.…”

“…4,11 This last mechanism seems to play an important role in pediatric EBTB. 4,12,13 In fact, we report two cases of complete endobronchial obstruction with caseous/mucoid material with an extremely high tendency to recurrence. Some authors have reported that lymph node erosion into the bronchus may lead to lymphobronchial fistula through inflammation and necrosis.…”

“…Interestingly, an immune‐mediated theory has also been suggested: anti‐TB drugs may be a trigger for granuloma formation by releasing tuberculin via a cell‐mediated hypersensitivity reaction. This theory has therapeutic implications, as medications such as corticosteroids could presumably suppress this reaction 12 . Nevertheless some patients may present with endobronchial granuloma without receiving any anti‐TB drugs.…”

Tracheobronchial Foreign Bodies in Children: Imaging Assessment

“…8 Endobronchial involvement in tuberculosis is related to mucosal involvement such as inflammation, ulceration, or granuloma formation. 30 Nontuberculous mycobacteria such as mycobacterium avium can also cause endobronchial granulomas and has been reported even in immunocompetent children. 31 Fibrosing mediastinitis, also known as mediastinal fibrosis or sclerosing mediastinitis, is characterized by abnormal proliferation of acellular collagen and fibrous tissue in the mediastinum.…”