Intracavitary and endobronchial tuberculosis.

We present the case of an interesting and unusual bronchoscopic finding in a 46-year-old African American woman who had been homeless for 10 years and resided in an inner city train station. She presented with cough and significant weight loss. Chest X-ray showed bilateral cystic and bullous interstitial infiltrates. CT scan of the chest revealed diffuse cystic bronchectasis, cavitary and nodular infiltrates, and a large cavitary lesion in the right upper lobe. During bronchoscopy, the airway demonstrated that the anterior segment of the right upper lobe bronchus was contiguous with an opening to a right-sided cavity, which was lined with inflammatory and necrotic material. The areas were brushed and lavaged for culture and cytology. There were patchy whitish lesions noted diffusely on the tracheal wall, which was also brushed and cultured. Acid fast bacilli smears were strongly positive from the bronchial washing. The patient was started on four-drug therapy for tuberculosis.