Tumoral Form of Endobronchial Tuberculosis in an Infant With Central Nervous System Involvement

To the Editor, Endobronchial tuberculosis (EBTB) refers to the infection of the tracheobronchial mucosa by the tuberculosis bacillus, which can manifest in several forms, including nonspecific bronchitis, edematous-hyperemic, caseating, granular, ulcerative, tumorous, or fibrostenotic forms. The case of a 1-year-old male infant presenting with dyspnea in an emergency setting is described. This study was approved by the Research Ethics Committee of the Sociedade Beneficente Israelita Brasileira Albert Einstein (CAAE: 79620824.7.0000.0071), with registration on Plataforma Brasil, a national system for the registration and monitoring of all research projects involving human subjects in Brazil. The study adhered to internationally recognized ethical standards, in accordance with the Declaration of Helsinki. The patient was undergoing treatment for central nervous system tuberculosis. Bronchoscopy revealed a vegetative lesion completely obstructing the right upper lobe bronchus, projecting into the main bronchus with a valve mechanism (Figure 1). The lesion was resected during bronchoscopy using biopsy forceps, restoring airway patency. The final pathological examination revealed a granulomatous inflammatory process with caseous necrosis. EBTB is rare in infants but has been documented in 30% to 60% of children with primary pulmonary tuberculosis [1]. Proposed pathophysiological mechanisms include erosion of a compromised lymph node into the bronchus, continuity-based injury from the lung parenchyma, bacillus implantation from secretion onto the mucosa, and hematogenous or lymphatic dissemination. It is essential to initiate diagnostic investigations with bronchoscopy and restore airway patency when necessary, based on clinical and radiological suspicion. This case highlights the importance of early recognition and intervention in endobronchial tuberculosis, particularly in pediatric patients with central nervous system involvement. The timely use of bronchoscopy for both diagnosis and treatment can restore airway patency and improve clinical outcomes [2, 3]. Mariana S. Conte: investigation, conceptualization, funding acquisition; writing–original draft, visualization, writing–review and editing. Victor A. Ohannesian: methodology, validation, visualization, writing–review and editing, writing–original draft, project administration, data curation. Altair S. Costa Junior: conceptualization, data curation, supervision, resources, formal analysis. Marcia Jacomelli: supervision, conceptualization, investigation, methodology, writing–review and editing, writing–original draft. The patient's consent was waived for this specific case, in accordance with the policy of the institutional ethics committee of Sociedade Beneficente Israelita Brasileira Albert Einstein (CAAE: 79620824.7.0000.0071), registered on Plataforma Brasil, a national system for the registration and monitoring of research involving human subjects. The authors declare no conflicts of interest. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.