Catastrophic Hemoptysis in Concurrent Laryngeal and Endobronchial Tuberculosis in an Immunocompetent Host: Survival Following Brief ECMO Support.

We present a case of a 45-year-old previously healthy Filipino domestic helper who presented with life-threatening hemoptysis due to disseminated tuberculosis (TB) involving the larynx, tracheobronchial tree, and pulmonary parenchyma. She presented with acute respiratory distress from massive hemoptysis, necessitating emergent intubation and subsequent veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) support. Initial chest radiography revealed bilateral upper lobe infiltrates and right middle lobe collapse. Bronchoscopic evaluation demonstrated active haemorrhage and airway obstruction secondary to clot formation. An incidental epiglottic mass was identified during laryngoscopy. Given the failure of conservative measures to control bleeding, she underwent emergent right middle and lower lobectomies. Histopathological analysis confirmed necrotizing granulomatous inflammation, and Mycobacterium tuberculosis was detected via polymerase chain reaction (PCR) testing. She was treated with a multi-drug anti-tuberculosis regimen and successfully weaned from ECMO. The epiglottic mass resolved, and there was no tracheal stenosis. This case illustrates the complexities of managing tuberculosis-related respiratory failure. It demonstrates the strategic role of ECMO in handling massive hemoptysis, especially in cases of concurrent laryngeal TB (LTB) and endobronchial TB (EBTB).