A 1-year-old boy with near-complete tracheobronchial obstruction from endobronchial tuberculosis

A one-year-old boy was referred to our respiratory department for further evaluation of obstructing endobronchial lesions. The lesions were detected on chest computed tomography (CT) performed at another hospital after the patient presented with cough and worsening wheezing. Physical examination revealed tachypnea and diminished breath sounds bilaterally without rales. The patient was receiving supplemental oxygen. Notably, his medical history was significant for an admission at 21 days of age for persistent cough, right upper lung atelectasis, and sputum analysis that revealed Bordetella pertussis, Acinetobacter baumannii, and rhinovirus. Despite advanced testing, including bronchoalveolar lavage acid-fast staining, tuberculin skin testing, and metagenomic next-generation sequencing, the diagnosis was initially missed and was ultimately established only after multi-institutional pathology review with deeper histologic recuts identifying a rare acid-fast bacillus. This case demonstrates a rare but high-risk presentation of pediatric tuberculosis: near-complete tracheobronchial obstruction due to endobronchial tuberculosis (EBTB) in an infant.