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BMJ Case Reports 2018; doi:10.1136/bcr-2018-225275
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Adenobronchial fistula secondary to tuberculosis in an immunocompetent adult patient

  1. Marta García Clemente1
  1. 1Department of Respiratory Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain
  2. 2Department of Radiology Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain
  1. Correspondence to Claudia Janeth Madrid Carbajal, claudiamadrid9{at}hotmail.com
  • Accepted 16 October 2018
  • Published 3 November 2018

Description 

A 72-year-old patient, retired miner, with no history of interest, which comes for an irritative cough with dark expectoration of 9 months of evolution. On physical examination, the patient was haemodynamically stable, afebrile and without notable alterations. No alterations were observed in the blood analysis and chest X-ray. A sputum microbiological study was performed observing resistant alcohol-acid bacilli, with positive Xpert Mycobacterium tuberculosis (MTB)/Rifampicin (RIF) study and culture of mycobacteria with MTB isolate sensitive to all first-line drugs. A chest CT scan showed calcified mediastinal and bilateral hilar adenopathies, a bilateral micronodular interstitial pattern suggestive of pneumoconiosis and an increase in pseudonodular density with a bronchogram on right interior lobe (RIL) suggestive of an infectious process. An air cavity of subcarinal localisation with fistulisation to both main bronchi is observed in relation to adenopathy with necrosis (figure 1A). A bronchoscopy was performed in which a fistulous orifice with thick discharge communicating through the subcarinal region with a fistula to the medial wall of the left main bronchus was observed in the medial …

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