A 44 year-old male former heavy smoker was referred to our hospital for an abnormal chest radiograph and cough. He reported productive cough, fevers and night sweats for three weeks. On review of systems he had an unintentional weight loss of 40 lbs over the previous four months. He never had a tuberculin

skin test (TST) and denied tuberculosis contacts or wheezing. He was originally from Ecuador and had a history of right lower lobe pneumonia in the previous two years. A TST placed on admission was positive (20 mm). Decreased breath sounds on auscultation and dullness on percussion were appreciated at the right base. Blood tests revealed only mild leukocytosis (13,300 cells/uL) without bandemia. His basic GSI-IX molecular weight metabolic panel and liver function panel results were unremarkable. The patient’s posteroanterior and lateral chest radiographs are shown Protease Inhibitor Library clinical trial in Fig. 1A–B. Chest CT images (axial and coronal views) are shown in Fig. 2A–B. Pulmonary function tests were normal. Flexible bronchoscopy showed a smooth round white polypoid lesion with wide base at the distal end of bronchus intermedius almost

completely occluding the lumen (Fig. 3). White thick mucoid substance could be seen exuding from the right middle lobe bronchus. Our patient underwent bilobectomy and a biopsy of the polypoid lesion is shown in Fig. 4A–B. The diagnosis of an endobronchial leiomyoma causing complete obstruction of bronchus intermedius was made. Endobronchial leiomyomas are extremely rare benign tumors; Forkel reported the first case in 1909 [1]. They account for 33–45% of all pulmonary leiomyomas [2] and [3], U0126 solubility dmso and are usually found in young middle age patients (39.1 years in average) without sex predilection [2] and [4]. Clinical presentation depends on the location of the tumor, its size and changes in the lung distal to the lesion. Bronchial lesions produce symptoms due to partial or complete obstruction of the affected

bronchus, which may include wheezing, orthopnea, hemoptysis, recurrent pneumonia and subsequent bronchiectasis [5]. Kwon described cough, dyspnea and fever as major symptoms in pulmonary leiomyomas in the case series he reported [6]. Our patient had all of those symptoms. Endobronchial lesions comprise a heterogeneous group of pathologic entities (Table 1). Only 10% are benign tumors, papilloma being the most common form [7]. Our patient presented with recurrent pneumonia, significant weight loss and a positive TST, which lead to the presumptive diagnosis of active tuberculosis. However, sputum smear analysis was negative for acid-fast bacilli (AFB). Since endobronchial tuberculosis (EBTB) is sputum positive for AFB only in 16–53.3% [8], and out patient was originally from a high-endemic area, we decided to start empirical treatment for endobronchial tuberculosis.