Endotracheal Tuberculosis and Aspergillosis Co-Infection Manifested as Acute Respiratory Failure: A Case Report

Background: Endotracheal and endobronchial tuberculosis are defined by microbiological and histopathological evidence of tuberculosis involving tracheobronchial tree, with or without parenchymal involvement. Tracheal tuberculosis is a rare and localized form of tuberculosis which can present itself with acute respiratory failure due to upper airway obstruction. Case presentation: We present a case of a 62 year old female with a diagnosis of pulmonary tuberculosis, who was admitted to the emergency department of our hospital with severe dyspnea, which rapidly progressed to acute respiratory failure requiring tracheal intubation and mechanical ventilation. A four-drug anti-tuberculosis (TB) regimen, consisting of isoniazid, rifampicin, pyrazinamide and ethambutol, was started one month before and identification of a sensitive Mycobacterium tuberculosis strain was made at that time. During medical investigation, tracheobronchial tuberculosis and endotracheal aspergillosis co-infection were diagnosed by bronchoscopy and histological examination. Conclusion: This uncommon case illustrates a severe clinical presentation of tracheobronchial tuberculosis with concomitant diagnosis of tracheal aspergillosis. It underlines the importance of a prompt diagnosis and treatment of tracheal tuberculosis and co-incidental infections in order to prevent serious complications, such as bronchostenosis and bronchomalacia. The bronchoscopic examination is the key for microbiological and histopathological confirmation of tracheobronchial involvement for both tuberculosis and aspergillosis. Corticosteroid therapy combined with anti-TB regimen remains controversial for endobronchial TB and its impact on patients’ outcome is not well documented.