Byline: Yan. Dang, Xiaopeng. He, Jia. Wei
BACKGROUND: Bronchial anthracofibrosis is a common disease that has been reported in the past. We aim to summarize the clinical characteristics of bronchial anthracofibrosis combined with tuberculosis infection to reduce missed diagnosis. METHODS: The clinical features of two cases of bronchial anthracofibrosis combined with tuberculosis were analyzed retrospectively, and relevant studies were reviewed. RESULTS: The two patients were both elderly individuals who presented with chronic cough and expectoration. Pigmentation in the bronchus mucosa and stenosis of lumen were observed during bronchoscopy. Tuberculosis infection was confirmed by biopsy. The symptoms were remarkably relieved and no recurrence was found after anti-tuberculosis treatment. CONCLUSION: Bronchial anthracofibrosis may be combined with tuberculosis. To avoid misdiagnosis, we should be aware of possible tuberculosis infection when patients are diagnosed with bronchial anthracofibrosis.
Bronchial anthracofibrosis is a common disease that has been frequently reported in the past. Chung et al . named it in 1998. It refers to bronchial stenosis or obstruction with anthracotic pigmentation in the mucosa in patients who are not exposed to dusty environments and without smoking history. Lymph nodes adjacent to the bronchus can be enlarged and calcified; computed tomography (CT) often reveals atelectasis of adjacent lung tissue. Bronchial anthracofibrosis also presents as proliferation of fibrous tissue in mediastinum. This proliferation can cause stenosis of the adjacent trachea, esophagus and pulmonary vessels, possibly leading to superior vena cava syndrome. At first, many researchers reported it as an independent clinical entity (i.e., independent clinical, pathological, radiological, and bronchoscopic characteristics). These patients began to be noticed by researchers and such reports gradually increased. A segment of the patient population has concomitant tuberculosis infections. Researchers realized that bronchial anthracofibrosis is closely related to active or latent pulmonary tuberculosis. At present, there are few reports of bronchial anthracofibrosis combined with tuberculosis in China and abroad. In recent years, we encountered two cases in clinical practice. Here, we review the clinical features of these patients, aiming to raise awareness of disease.
Case 1 is a female, 68-year-old. She complained chronic cough, expectoration, and wheezing for more than 10 years, with recurrence associated with intermittent fever for 1 month. She was hospitalized. The patient denied particular exposure history and tuberculosis infection history. Symptoms were cough, expectoration, and wheezing with large amount of white mucilage phlegm that occurred intermittently more than 10 years ago. Symptoms tended to reoccur during cold weather in autumn and winter. She was diagnosed with chronic bronchitis at a local hospital. Her symptoms were relieved after treatment in the local hospital for an exacerbation. No bronchoscopy had been performed during the course of her illness. Due to the aggravation of symptoms, she was treated in a local hospital 7 months prior to admission. The usual treatment had poor effects this time, and she came to our hospital for further diagnosis and treatment. Chest CT revealed large exudative foci and consolidation in the left lower lung. Bronchoscopy revealed stenosis in the left upper and lower lobes with pigmentation....