A Case of Laryngeal Tuberculosis, Endobronchial Tuberculosis and Pulmonary Tuberculosis Coexistent in an Immunocompetent Host

Abstract

Historically associated with poor prognosis seen in advanced disease, laryngeal tuberculosis (LTB) now represents only 1% of all cases of tuberculosis (TB). The incidence of LTB has decreased drastically with the introduction of anti-tubercular drugs. LTB can be primary or secondary to pulmonary tuberculosis. LTB can mimic laryngeal cancer. We present a case of primary laryngeal TB with descending tracheobronchial spread in an immunocompetent 71-year-old female who developed progressive dysphonia over several months with unintentional weight loss and non-productive cough. Non-contrast enhanced computed tomography (CT) revealed clustering of subcentimeter stellate nodules in the right upper lung field with an enlarging ground-glass opacity in the right lower lung but did not show structural abnormalities within the neck. Positron emission tomography (PET) showed pathologic fluorodeoxyglucose (FDG) uptake within the larynx and trachea with extension into the left mainstream bronchus as well as the proximal left upper and lower lobe bronchi. Diffuse standardized uptake value (SUV) was greatest in the larynx (20.5). Polymerase chain reaction (PCR) on bronchoscope sputum specimen confirmed Mycobacterium tuberculosis. Findings were consistent with primary laryngeal TB with endobronchial extension. She was started on a four-drug regimen comprising of isoniazid, rifampin, ethambutol, and pyrazinamide with a good response. Her close contacts were treated as well. This case highlights the unusual spread of primary laryngeal TB in an immunocompetent host. Early diagnosis can limit adverse complications and unnecessary exposure to healthcare workers. To our knowledge, this is the first case of primary LTB with proximal spread to the tracheobronchial and pulmonary tuberculosis.

Tuberculosis laríngea y pulmonar en un hombre inmunocompetente de 45 años: presentación de un caso

“…En general, es más frecuente la TB laríngea asociada con TB pulmonar que la TB laríngea primaria, y en el caso de este paciente, no es fácil establecer la cronología, por la simultaneidad de los síntomas. El compromiso sincrónico en un paciente inmunocompetente constituye uno de los pocos casos reportados en la literatura (4).…”

Life-Threatening Stridor due to Laryngeal Tuberculosis in the COVID-19 Era: Report of a Case

“…18 In the time of COVID-19 pandemic, we should never underestimate other severe infectious diseases, even in immunocompetent hosts. 19 Environmental control and personal protection are aspects that physicians could overlook when treating patients, 20 so we should always be aware of the environment and choose the most suitable place to perform an urgent tracheostomy or laryngoscopy. 6 As a conclusion, compromised airway due to laryngeal tuberculosis is a rare condition that may require urgent tracheostomy.…”

Bifocal Tuberculosis with Adalimumab Revealed by Laryngeal Involvement: Case Report

“…Laryngeal tuberculosis is observed very rarely (0.5-2% of patients with tuberculosis), usually with immunocompromised diseases. It is the most common granulomatous disease of the larynx and represents less than 1% of all forms of tuberculosis [11,12].…”

“…Several sites may be affected: vocal cords (50-70%), false vocal cords (40-50%), epiglottis, subglottic region, and posterior commissure (10-15%). Symptoms of laryngeal tuberculosis are dysphonia, hoarseness, wasting, dysphagia and odynophagia [11][12][13][14][15][16].…”