A Report of Two Cases of Tuberculosis With Bronchial Anthracofibrosis: Diagnostic Challenges and Therapeutic Approaches.

A clinical entity that was reported less than ten years ago, bronchial anthracofibrosis is marked by multifocal bronchial lumen constriction and anthracotic coloring of the bronchial mucosa. There is various etiology associated with "black bronchoscopy". A 47-year-old woman with no known co-morbidities reported having a three-month history of coughing up sputum. She had been complaining of intermittent fever and weight loss for a month. Right upper zone heterogeneous opacity was visible on the chest X-ray. Additionally, she reported unilateral leg pain and swelling, which a Doppler examination revealed to be right deep vein thrombosis (DVT). PET-CT scan results for the patient revealed persistently active bilateral lung Koch's infection accompanied by healing mediastinal lymphadenopathy. Analyses of sputum were not helpful. Another patient, a 57-year-old male patient with a month-long period of severe weight loss, loss of appetite, and sporadic cough with expectoration was reported. He was not a smoker and had no known comorbidities. An unremarkable general examination was followed by systemic examinations that revealed crepitation in the interscapular and right mammary regions. The right lower zone of a chest X-ray revealed heterogeneous opacities. Both patients underwent bronchoscopy, which showed the presence of bronchial anthracosis and anthracofibrosis. Although the most common cause of these black pigmentations is dust exposure, tuberculosis can also present as bronchial anthracofibrosis. Enhanced diagnostic strategies, including advanced imaging techniques and bronchoscopic evaluation, are essential to distinguish between these conditions accurately and to guide treatment.