Article Text

PDF

Post-tuberculous fibrosing mediastinitis: a review of the literature
  1. Zhe Wu1,
  2. Hannah Jarvis2,
  3. Luke S Howard3,
  4. Corrina Wright4 and
  5. Onn Min Kon1
  1. 1 Department of Respiratory Medicine, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
  2. 2 Imperial Clinical Respiratory Research Unit, Imperial College London, London, UK
  3. 3 National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, UK
  4. 4 Department of Cytopathology, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Onn Min Kon; onn.kon{at}nhs.net

Abstract

Fibrosing mediastinitis (FM) is a rare disease where there is thickening of the fibrous tissue in the mediastinum. While histoplasmosis is the the most common recognised cause, the link with tuberculosis (TB) has been rarely documented. We review the link between TB and FM, and describe a case of probable TB-related FM.Our case is of a 74-year-old man who presented with breathlessness 3 years after fully treated TB. Scans revealed a calcified soft tissue mass within the mediastinum, and a diagnosis of fibrosing mediastinitis resulting in pulmonary hypertension was made. Tests for histoplasmosis and IgG4 staining were negative. Surgical intervention was not felt to be beneficial, and he was treated with prednisolone and mycophenolate mofetil.In the review, we highlight the two forms of mediastinitis—granulomatous versus fibrous, and how these two entities may be on a spectrum of disease progression. We also explore the prevalence, clinical presentation, pathogenesis, imaging techniques and treatment options of TB-related FM.

  • Tuberculosis

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

Statistics from Altmetric.com

Footnotes

  • Contributors ZW and OMK are responsible for the conception, drafting, revision and final approval of the article. HJ, LSH and CW are responsible for reviewing the article, making critical amendments and were directly involved with the clinical care of the patient.

  • Funding OMK is supported by the Biomedical Research Centre.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Due to patient confidentiality, there is limited further data, but may be available by contacting the corresponding author.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.