On the pathogenesis of post primary tuberculosis: The role of bronchial obstruction in the pathogenesis of cavities

SummaryMycobacterium tuberculosis produces two distinct types of disease: primary and post primary tuberculosis. We recently reported that post primary tuberculosis begins in immunocompetent adults as an endogenous lipid pneumonia that abruptly undergoes necrosis to produce cavities. Obstruction of bronchi by endobronchial tuberculosis is a consistent finding in developing post primary tuberculosis. This paper reports a case of obstructive pneumonia caused by cancer that underwent rapid necrosis to produce a cavity that was similar to those produce by tuberculosis. Analysis of this case with the relevant literature supports the hypothesis that bronchial obstruction is an essential contributor to the development of post primary tuberculosis and that it may help explain the localized suppression of host defense mechanisms in adult pulmonary tuberculosis.