Acute Endobronchial Dissemination of a Tuberculoma Following EBUS-GS-Guided Transbronchial Biopsy: A Case Report

Post-bronchoscopy infections are usually bacterial, whereas procedure-associated endobronchial dissemination of Mycobacterium tuberculosis is rarely reported. A 52-year-old woman with poorly controlled diabetes (HbA1c 13.8%) had a 19-mm left upper-lobe nodule radiologically suspicious for lung cancer. Because tissue confirmation was required and tuberculosis remained in the differential diagnosis (positive T-SPOT.TB on admission), endobronchial ultrasonography with a guide sheath (EBUS-GS)-guided transbronchial biopsy was performed under airborne precautions. Bronchial lavage smear and loop-mediated isothermal amplification were positive for M. tuberculosis, and histology showed extensive caseous necrosis with numerous acid-fast bacilli, consistent with a tuberculoma. Two days later, she developed a 39°C fever with rapid cavitation of the primary lesion and new ipsilateral tree-in-bud opacities. No bacterial pathogens other than M. tuberculosis were identified despite empirical ceftriaxone. Standard antituberculosis therapy led to clinical and radiological improvement.