Diagnostic Dilemma: Investigating Respiratory Symptoms in a Middle-Aged Smoker

This case report presents a diagnostic challenge encountered in a 65-year-old male admitted with fever, dyspnea, chest pain, and hemoptysis, alongside constitutional symptoms including weight loss, night sweats, and fatigue. Despite initial suspicion for pulmonary thromboembolism and empirical antibiotic therapy for pneumonia, subsequent bronchoscopic evaluation revealed acute necrotizing granulomatous bronchitis, strongly indicative of endobronchial tuberculosis (TB). This diagnosis emphasizes the importance of considering TB in patients with chronic respiratory symptoms, particularly in high-risk populations. Management involves initiating multidrug antitubercular therapy, close monitoring, infection control measures, and patient education. Prompt diagnosis and appropriate management are crucial in optimizing outcomes and reducing disease burden in TB.