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Case reports: Pulmonary destructive lesions caused by ankylosing spondylitis

Senlin Zhan¹, Hongyi Zhang¹, Qiaoli Peng²

¹Department of Pulmonary Medicine and Tuberculosis, The Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China.

Journal of Clinical Tuberculosis and Other Mycobacterial Diseases

|April 22, 2026

Abstract

Background:

Ankylosing spondylitis (AS) frequently produces thoracic-cage deformities-kyphosis and rib fusion-that restrict chest expansion and impair ventilation, occasionally progressing to atelectasis or pulmonary fibrosis. Such pulmonary manifestations are often misdiagnosed as tuberculosis or fungal disease.

Case Presentation:

We describe two AS patients with bilateral upper-lobe destruction whose initial chest CT scans suggested tuberculosis. After thorough microbiological work-up remained negative, both were diagnosed with AS-associated lung injury (ASLI) and referred to rheumatology. Because destroyed lung carries lifelong risks of infection and hemorrhage, long-term respiratory follow-up was recommended.

Conclusion:

We describe two AS patients with bilateral upper-lobe destruction whose initial chest CT scans suggested tuberculosis. After thorough microbiological work-up remained negative, both were diagnosed with AS-associated lung injury (ASLI) and referred to rheumatology. Because destroyed lung carries lifelong risks of infection and hemorrhage, long-term respiratory follow-up was recommended.

Keywords:

AS-associated lung injury (ASLI)Ankylosingspondilitis(AS)Pulmonary abnormalities Pulmonary destructed damages

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