CHEST Guidelines-A-21-Year-Old-Immune-Competent-Man-With-Recurrent-

A-21-Year-Old-Immune-Competent-Man-With-Recurrent-

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The document narrates the medical case of a 21-year-old Chinese man who was diagnosed with mediastinal tuberculous lymphadenitis with a bronchial fistula. The individual, presenting with a nonproductive cough for five months, had an elevated leukocyte and neutrophil count and a positive TB test. Initial treatment with anti-TB drugs (ethambutol, isoniazid, pyrazinamide, and rifapentine) failed to relieve symptoms, prompting further examination.<br /><br />Subsequent diagnostic efforts, involving bronchoscopy and a lymph node biopsy, showed necrosis and confirmed the presence of Mycobacterium tuberculosis. CT scans identified mottled opacification and enlarged lymph nodes, which reduced in size after treatment. The Xpert MTB/Rif test confirmed Mycobacterium tuberculosis susceptible to rifampicin, but cultures were negative. Ultimately, the patient was diagnosed with a bronchial fistula, a rare complication of extrapulmonary tuberculosis, where lymph node erosion into the bronchus occurs.<br /><br />Despite being immune-competent, the patient suffered from this rare and persistent condition, which often leads to prolonged treatment and increased risks due to potential drug resistance. His treatment regimen included the standard quadruple therapy along with cryotherapy and local isoniazid injections during bronchoscopy. Follow-up after one year showed improvement and closure of the fistula.<br /><br />The document emphasizes that such extrapulmonary TB complications, although rare, are becoming more frequent, particularly in China. It highlights the necessity of close monitoring post-diagnosis and suggests that complications like the bronchonodal fistula require extended surveillance. Moreover, the case draws attention to the risks of delayed diagnosis, disease progression, and increased transmission, stressing the importance of early and effective management strategies.

Keywords

mediastinal tuberculous lymphadenitis

bronchial fistula

Mycobacterium tuberculosis

anti-TB drugs

extrapulmonary tuberculosis

bronchoscopy

cryotherapy

China

drug resistance

early diagnosis