Background:
Endobronchial Tuberculosis (EBTB) is a challenging form of tuberculosis that affects the tracheobronchial tree and frequently mimics neoplastic conditions due to its nonspecific clinical, radiological, and bronchoscopic presentations.

Case presentation:
We present the case of an 83-year-old female with a history of smoking who developed progressive respiratory symptoms. Initial imaging revealed a right upper lobe lesion, raising concerns of malignancy. Despite no prior history of tuberculosis, the clinical and radiological findings were strongly suggestive of cancer. Fiberoptic bronchoscopy revealed nodular lesions within the trachea and a necrotic obstructing mass in the right upper lobe bronchus. Histopathological examination of biopsy samples showed granulomatous inflammation with multinucleated giant cells and caseating necrosis. Cultures from bronchial aspirates confirmed the presence of Mycobacterium tuberculosis. The patient responded well to antituberculous therapy, significantly improving clinical symptoms and radiological findings.

Discussion:
This case highlights the diagnostic challenges EBTB posed, particularly its ability to masquerade as a malignancy. EBTB can present with highly variable radiological patterns, complicating diagnosis. Bronchoscopy is pivotal in identifying lesions, while histopathological examination is essential for confirming tuberculosis in suspected cases. In patients, particularly those with risk factors like smoking, a high index of suspicion is necessary to avoid delays in diagnosis and treatment.

Conclusion:
EBTB should be considered in the differential diagnosis of tracheobronchial lesions, especially in smokers and those with radiological findings suggestive of cancer. Early diagnosis through a multidisciplinary approach—incorporating bronchoscopy, imaging, microbiology, and histopathology—is essential for initiating timely antituberculous therapy, preventing complications, and improving patient outcomes. This case underscores the importance of thorough diagnostic evaluations in complex cases of respiratory disease.