Tumorous Endobronchial Tuberculosis Mimicking Lung Neoplasm: A Diagnostic Challenge in a Middle-aged Female

Endobronchial tuberculosis is a distinct form of pulmonary tuberculosis involving the tracheobronchial tree and may present with varied bronchoscopic appearances. The tumorous subtype is rare and can closely mimic malignancy both clinically and radiologically, leading to diagnostic dilemmas and potential delays in appropriate treatment. A 45-year-old female presented with a 1-month history of progressive dyspnea (modified Medical Research Council Grade II), cough with mucoid expectoration, low-grade fever with evening rise, and significant weight loss. She was a known case of obstructive airway disease and type 2 diabetes mellitus. Chest radiography revealed a nonhomogeneous opacity in the left hilar region with bilateral hyperinflation. High-resolution computed tomography (CT) showed a well-defined lobulated hypodense mass in the lingular segment of the left lung, while contrast-enhanced CT demonstrated an irregular soft-tissue lesion extending from the hilum to the left upper lobe with branching projections, raising suspicion of malignancy. Bronchoscopy revealed a vascular, nonpedunculated polypoidal mass in the left lingular segment, causing luminal narrowing. However, cytology and histopathology were negative for neoplastic cells. Bronchoalveolar lavage CBNAAT detected Mycobacterium tuberculosis with rifampicin sensitivity, confirming the diagnosis of endobronchial tuberculosis. The patient was initiated on standard antitubercular therapy for 6 months, resulting in symptomatic improvement. Follow-up imaging and bronchoscopy showed partial resolution with residual lesion, leading to extension of therapy to a total of 9 months. Continued clinical and radiological improvement was observed. Tumorous endobronchial tuberculosis can closely mimic lung malignancy and should be considered in the differential diagnosis of endobronchial masses, especially in endemic regions. Early bronchoscopy combined with molecular diagnostic tools such as CBNAAT is crucial for accurate diagnosis and timely initiation of therapy, thereby preventing unnecessary invasive procedures and long-term complications such as bronchial stenosis.