The Silent Sentinel’s Breach: Middle Lobe Syndrome Caused by Endobronchial Rupture of Mediastinal Tuberculous Lymphadenitis
Year: 2026
Type: article
Study design: Case Report
Abstract: were negative. Chest CT confirmed necrotic mediastinal lymph nodes with endobronchial rupture into the middle lobe bronchus and cavitated middle lobe consolidation. Flexible bronchoscopy demonstrated mucosal infiltration and pearly-white stenosis of the middle lobar bronchus. Endobronchial biopsies revealed necrotizing epithelioid and giant-cell granulomatous inflammation. The diagnosis of obstructive MLS secondary to endobronchial tuberculosis following lymph node rupture was established, and antituberculosis therapy was initiated. In conclusion, tuberculous lymphadenitis with broncho-nodular fistulization should be considered in the etiology of obstructive MLS. Initial empirical fluoroquinolone treatment can mask bacteriological detection, highlighting the essential diagnostic role of endobronchial biopsies.
Source: Cureus
Authors: Houda Snene, Monia Attia, Imen Alioua, Nadia Mehiri, Bechir Louzir
Institutions: Hôpital Mongi Slim, Tunis El Manar University
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7204203711