Lymph node perforation into the airway in AIDS-associated tuberculosis

A 27 year old African woman infected with the human immunodeficiency virus (HIV) presented with pulmonary complaints. Her sputum smears were positive for acid-fast bacilli (AFB). Chest roentgenogram showed right mediastinal and hilar adenopathy with a right pulmonary infiltrate. At fibreoptic bronchoscopy, mucosal infiltration with perforation and presence of thick caseum was detected in the bronchus intermedius confirming the diagnosis of a perforated lymph node. This case demonstrates that a more liberal indication of bronchoscopy helps in evaluating the impact of enlarged intrathoracic lymph nodes on neighbouring bronchi, leading to earlier detection of endobronchial tuberculosis in patients with the acquired immune deficiency syndrome (AIDS).