title: Treatment of multiple-level tracheobronchial stenosis secondary to endobronchial tuberculosis using bronchoscopic balloon dilatation with topical mitomycin-C.
abstract: BACKGROUND
  Tracheobronchial stenosis is a known complication of endobronchial tuberculosis. Despite antituberculous and steroid therapy, the development of bronchial stenosis is usually irreversible and requires airway patency to be restored by either bronchoscopic or surgical interventions. We report the use of balloon dilatation and topical mitomycin-C to successful restore airway patency.
  
  
  METHODS
  We present a 24-year old lady with previous pulmonary tuberculosis and laryngeal tuberculosis in 2007 and 2013 respectively who presented with worsening dyspnoea and stridor. She had total left lung collapse with stenosis of both the upper trachea and left main bronchus. She underwent successful bronchoscopic balloon and manual rigid tube dilatation with topical mitomycin-C application over the stenotic tracheal segment. A second bronchoscopic intervention was performed after 20 weeks for the left main bronchus stenosis with serial balloon dilatation and topical mitomycin-C application. These interventions led to significant clinical and radiographic improvements.
  
  
  CONCLUSIONS
  This case highlights that balloon dilatation and topical mitomycin-C application should be considered in selected patients with tracheobronchial stenosis following endobronchial tuberculosis, avoiding airway stenting and invasive surgical intervention.
authors.affiliation: Department of Medicine, Respiratory Unit, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia. arabinose@hotmail.com.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Faisal
authors.affiliation: Respiratory Unit, Serdang Hospital, Jalan Puchong, 43000, Kajang, Selangor Darul Ehsan, Malaysia.
authors.forename: Hafaruzi
authors.initials: H
authors.lastname: Harun
authors.affiliation: Department of Medicine, Respiratory Unit, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia.
authors.forename: Tidi M
authors.initials: TM
authors.lastname: Hassan
authors.affiliation: Department of Medicine, Respiratory Unit, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia.
authors.forename: Andrea Y L
authors.initials: AY
authors.lastname: Ban
authors.affiliation: Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
authors.forename: Sanjay H
authors.initials: SH
authors.lastname: Chotirmall
authors.affiliation: Respiratory Unit, Serdang Hospital, Jalan Puchong, 43000, Kajang, Selangor Darul Ehsan, Malaysia.
authors.forename: Jamalul Azizi
authors.initials: JA
authors.lastname: Abdul Rahaman
mesh_terms: D000287:Administration, Topical; D001980:Bronchi / Q000000981:diagnostic imaging* / Q000382:microbiology; D001982:Bronchial Diseases / Q000150:complications* / Q000175:diagnosis; D001999:Bronchoscopy / Q000379:methods*; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D004106:Dilatation / Q000379:methods*; D005260:Female; D006801:Humans; D016685:Mitomycin / Q000008:administration & dosage*; D019384:Nucleic Acid Synthesis Inhibitors / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed; D014135:Tracheal Stenosis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D014376:Tuberculosis / Q000150:complications* / Q000175:diagnosis; D055815:Young Adult
chemical_list: D019384:Nucleic Acid Synthesis Inhibitors; D016685:Mitomycin
keywords: Bronchoscopic intervention; Case report; Endobronchial tuberculosis; Mitomycin-C