A previously healthy 65-year-old female patient was admitted in the medical unit of our hospital with a history of fever and persistent cough 1 month ago. General examination was unremarkable except for the presence of pallor. Respiratory system examination revealed bronchial breath sounds and crackles in the right infraclavicular area. Examination of other systems was normal. A panel of laboratory tests was performed which confirmed iron deficiency anemia.
Chest radiogram showed right upper zone homogenous opacity. The patient was diagnosed to have community acquired pneumonia and was treated with broad spectrum antibiotics. She was referred to pulmonary medicine in the second week of admission to rule out post-obstructive pneumonia, as there was no clinical response to the above mentioned treatment. A computed tomography (CT) of the thorax was performed; it revealed dense peripheral consolidation of the right upper lobe with enlarged pre- and paratracheal lymph nodes (Figures 1(a) and 1(b)). As the lesion was deemed not amenable for CT guided biopsy, bronchoscopy was done; it showed mucoid, tenacious, and thick cheese-like pseudomembrane completely lining the right upper lobe bronchial subsegments with a narrow but patent bronchial lumen (Figure 1(c)). All other bronchial segments were normal. Bronchial washing from the right upper lobe bronchus was positive (+++) for acid fast bacilli (AFB). Biopsy of the pseudomembrane-like lining was attempted; satisfactory samples could be obtained as the latter was very tenacious. A diagnosis of endobronchial and parenchymal TB was made and antitubercular therapy was instituted.