When tuberculosis travels: granulomatous tracheitis leading to critical airway stenosis

Tuberculous tracheitis is an uncommon yet serious complication of tuberculosis (TB) infection. The underlying granulomatous inflammation typically results in tracheal stenosis within six months of diagnosis.This report details a case of a woman from Southeast Asia in her mid-40s who presented with chronic weight loss and cough. Imaging demonstrated pulmonary nodules as well as tracheal and oesophageal thickening. Bronchoscopy showed friable, ulcerated tracheal mucosa. Mycobacterium TB was confirmed on microbiological testing. Despite initiating anti-tuberculosis therapy with a standard 4-drug regimen, the patient presented with progressive dyspnoea and inspiratory stridor attributable to severe mid-tracheal stenosis. Multiple bronchoscopic interventions were needed to restore airway patency and prevent recurrent stenosis. This case highlights the importance of prompt recognition, timely intervention and regular follow-up to prevent fibrotic stenosis in tuberculous tracheitis.