Zhao Li, Guan Ruijuan, Yu Hong, Lin Jieru, Peng Chunhong, Yao Hongmei, Zhang Xiangyan, Ye Xianwei
Department of Respiratory Medicine, Guizhou Provincial People's Hospital, Guiyang 550002, China.
State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou 510030, China.
J Thorac Dis. 2018 Jul;10(7):E511-E515. doi: 10.21037/jtd.2018.07.03.
Anthracofibrosis, which was defined as a luminal narrowing associated with overlying anthracotic mucosa on bronchoscopy, has been infrequently reported. Recently, we have identified a case of patient who had a history of pulmonary tuberculosis (TB), manifested left main bronchial stenosis and hyperpigmentation. Despite repeated and multiple cryotherapy, the condition was still progressing. Given to the potential relationship between active endobronchial tuberculosis (EBTB) and anthracofibrosis, the patient received a diagnostic anti-tuberculosis (anti-TB) treatment due to initial failed cryotherapy, resulting in improvement of hyperpigmentation and stenosis of the left main bronchus. Eventually, the patient recovered well with regular anti-TB combined with intermittent cryotherapy. Our study suggests that even without etiological evidence, there might be an indication of therapeutic trial of anti-TB medication in case of repeated bronchial stenosis due to anthracofibrosis in patients with past history of TB and other causes are excluded. Yet, the recommendation of aggressive treatment should reply on the effect of diagnostic treatment and further research.
肺炭末纤维化被定义为支气管镜检查时与覆盖的炭末沉着性黏膜相关的管腔狭窄，此前鲜有报道。最近，我们发现了一例有肺结核病史的患者，表现为左主支气管狭窄和色素沉着。尽管反复多次进行冷冻治疗，病情仍在进展。鉴于活动性支气管内膜结核（EBTB）与肺炭末纤维化之间的潜在关系，由于最初的冷冻治疗失败，该患者接受了诊断性抗结核治疗，结果色素沉着和左主支气管狭窄得到改善。最终，患者通过规律的抗结核治疗联合间歇性冷冻治疗恢复良好。我们的研究表明，即使没有病因学证据，对于有肺结核病史且排除其他病因的患者，若因肺炭末纤维化导致反复支气管狭窄，可能有进行抗结核药物治疗性试验的指征。然而，积极治疗的建议应基于诊断性治疗的效果及进一步研究。
