Résumé

Introduction : Carinal perforation secondary to endobronchial tuberculosis is uncommon, and even less so from other infectious causes. We report a case of carinal perforation with bronchonodal fistula secondary to tuberculosis following bronchoscopy in an asthmatic patient followed at the Edgard Ouédraogo Clinic in Ouagadougou (Burkina Faso). Clinical case: A 33-year-old female patient with asthma was admitted for an asthma exacerbation. On admission, she was conscious with a Glasgow Coma Scale (GCS) score of 15, a WHO performance status of stage II, wheezing dyspnea, and a productive cough with difficulty expectorating. Emergency treatment with inhaled bronchodilator was initiated. Due to the lack of improvement after 5 days of treatment, a bronchoscopy was performed. This revealed a carina and the opening of the right main bronchus containing highly viscous, caseous purulent secretions strongly adhering to the bronchial mucosa. The Xpert MTB/RIF test on bronchoalveolar lavage detected Mycobacterium tuberculosis with moderate resistance to rifampicin. Antituberculosis treatment (2RHZE/4RH) was initiated. The patient's condition improved significantly, with a marked improvement in symptoms. Two months into his antituberculosis treatment, a follow-up bronchoscopy revealed lesions including a perforation of the carina with an outgrowth at the opening of the right main bronchus. His progress under antituberculosis treatment and maintenance corticosteroid therapy for asthma was favorable, with clinical and microbiological recovery at six months. Conclusion: This case illustrates the importance of considering tuberculosis in the event of an exacerbation of resistant asthma in an endemic area and the central role of bronchoscopy in the detection of rare but serious destructive complications such as carina perforation.

Mot-clés :

Endobronchial tuberculosis, perforation, carina, bronchoscopy, bronchoscopy