Primary Tracheal Rosai-Dorfman Disease Coexisting With Active Pulmonary Tuberculosis

Rosai-Dorfman disease (RDD) rarely involves the trachea, and active pulmonary tuberculosis (TB) has not been reported with tracheal RDD. A 35-year-old woman presented with progressive cough, wheezing, and shortness of breath for 1 month. Chest CT revealed a tracheal mass causing > 90% airway narrowing and left lung nodules suggestive of TB. Emergency bronchoscopic resection using high-frequency electrocautery relieved the obstruction. Histopathology showed emperipolesis and immunohistochemistry was consistent with RDD. Bronchial aspirate was positive for Mycobacterium tuberculosis complex by culture and GeneXpert, without rifampicin resistance. Standard anti-TB therapy was given. Two-month CT and one-year follow-up bronchoscopy and CT showed a patent airway without recurrence. The patient remained symptom-free with no other organ involvement. This is the first report of primary tracheal RDD coexisting with active pulmonary TB. Bronchoscopic resection combined with anti-TB therapy achieved durable disease control at 1 year.