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Chronic Tubercular Mediastinitis: A Rare Case Presentation With Subcutaneous Emphysema
Sumer S Choudhary1, Chetan R Khedkar2, Gaurang M Aurangabadkar3
1Respiratory Medicine, Datta Meghe Medical College and Shalinitai Meghe Hospital and Research Centre, Nagpur, IND.
Cureus
|June 12, 2023
Summary
This case study highlights an exceptionally rare instance of chronic mediastinitis caused by tuberculosis, presenting with a tracheal fistula and subcutaneous emphysema. Prompt anti-tubercular treatment led to successful fistula closure and symptom resolution.
Area of Science:
- Pulmonology
- Infectious Diseases
- Radiology
Background:
- Chronic mediastinitis is typically caused by fungal infections, malignancy, or sarcoidosis.
- Tuberculosis (TB) is a rare cause of chronic mediastinitis, and its association with tracheal fistula and subcutaneous emphysema is exceptionally uncommon.
Observation:
- A 35-year-old male with chronic alcoholism presented with cough, chest pain, weight loss, and fever.
- High-resolution Computed Tomography (HRCT) revealed pleural-based nodular lesions, ground-glass opacities, and two tracheal fistulas with subcutaneous emphysema extending to the abdomen.
- Video bronchoscopy and 3D virtual bronchoscopy confirmed the tracheal fistula.
Findings:
- Biopsy confirmed tuberculosis via positive acid-fast bacilli (AFB) stain, PCR, and tuberculin skin test.
- The patient was initiated on anti-tubercular therapy.
- Follow-up HRCT and bronchoscopy demonstrated fibrosing scarring and successful fistula closure after treatment.
Implications:
- This case underscores the importance of considering tuberculosis in the differential diagnosis of chronic mediastinitis, even with unusual presentations like tracheal fistulas.
- Early diagnosis and appropriate anti-tubercular treatment are crucial for favorable outcomes in such rare cases.
- The successful management highlights the efficacy of standard anti-TB regimens in complex thoracic infections.
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