title: Unusual clinical presentation of thoracic tuberculosis: the need for a better knowledge of illness.
abstract: BACKGROUND
  Pulmonary tuberculosis (TB), a highly contagious infectious disease, is a significant public health problem all over the world and remains an important cause of preventable death in the adult population. Endobronchial TB is an unusual form of thoracic TB that may be complicated by tracheobronchial stenosis, and bronchoesophageal fistula formation is a very rare complication. Tubercular lymphadenitis can also lead to fistula formation through a process of caseum necrosis and opening of a fistula between the bronchus and oesophagus.
  
  
  METHODS
  We report an uncommon case of thoracic TB in an immunocompetent 73-year-old Caucasian man who presented several problems: bronchoesophageal fistula, endobronchial TB, and mediastinal lymphadenopathy in the absence of contemporary parenchymal consolidation. Furthermore, he presented a normal chest radiograph and mostly unclear and non-specific symptoms at onset.
  
  
  CONCLUSIONS
  We emphasize the need for a better knowledge of this illness and awareness that it may have an unusual presentation. In these cases, diagnosis and proper treatment can be delayed, with severe complications for the patient. Pulmonary TB remains a real diagnostic challenge: a normal chest radiograph and nonspecific symptoms do not allow us to exclude this persistent infectious disease.
authors.affiliation: Department of Respiratory Disease, University of Sassari, Sassari, Italy.
authors.forename: Sandra
authors.initials: S
authors.lastname: Manca
authors.affiliation: Department of Respiratory Disease, University of Sassari, Sassari, Italy.
authors.forename: Alessandro Giuseppe
authors.initials: AG
authors.lastname: Fois
authors.affiliation: Department of Respiratory Disease, University of Sassari, Sassari, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Santoru
authors.affiliation: Thoracic Endoscopy and Pulmonology Unit, Maggiore Hospital, Bologna, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Trisolini
authors.affiliation: Department of Respiratory Disease, University of Sassari, Sassari, Italy.
authors.forename: Maria Francesca
authors.initials: MF
authors.lastname: Polo
authors.affiliation: Department of Respiratory Disease, University of Sassari, Sassari, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Ostera
authors.affiliation: Thoracic Endoscopy and Pulmonology Unit, Maggiore Hospital, Bologna, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Patelli
authors.affiliation: Department of Respiratory Disease, University of Sassari, Sassari, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Pirina
mesh_terms: D000368:Aged; D001983:Bronchial Fistula / Q000175:diagnosis / Q000209:etiology*; D001999:Bronchoscopy; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D013902:Radiography, Thoracic; D014057:Tomography, X-Ray Computed; D014388:Tuberculosis, Lymph Node / Q000150:complications / Q000175:diagnosis*