Primary Laryngeal Tuberculosis Manifesting as Irregular Vocal Fold Lesion

Abstract

Laryngeal tuberculosis is rare despite its close anatomical and physiological proximity to the lungs. It constitutes less than 1% of extrapulmonary tuberculosis. The symptoms of laryngeal tuberculosis are non-specific and mimic other laryngeal pathologies. The recent evolving and atypical endoscopic laryngeal features cause a diagnostic dilemma and delay in treatment. In this report, we presented three patients with distinct age and medical history, and hoarseness. Flexible videolaryngoscopy showed similar findings in the three cases, with irregular mucosa involving the entire length of the vocal fold, unilaterally in two cases and bilaterally in one. Mucosal waves were typically absent on laryngostroboscopy examination. The routine workup for pulmonary tuberculosis was unremarkable. The usage of Mycobacterium tuberculosis complex (MTBC) and rifampicin resistance (Xpert MTB/RIF) assay that detects Mycobacterium tuberculosis in the tissue biopsy specimens has helped in the rapid diagnosis of primary laryngeal tuberculosis and timely commencement of anti-tuberculous therapy. The clinical course and response to treatment were diverse in which two cases showed good response whilst the third developed disseminated tuberculosis despite optimal therapy.

Mycobacterium tuberculosis Resides in Macrophages in Laryngeal Tuberculosis: A Case Report

“…While a few previously reported cases have been documented by pathological examination of Ziehl-Neelsen-stained laryngeal tissues allowed for microscopic detection of acid-fast bacilli in tissues [16]; in this patient, M. tuberculosis localized in macrophages constituting granulomas in tuberculous laryngitis. Conventional microscopic examination of the laryngeal biopsy specimen by Ziehl-Neelsen staining showed acid-fast bacilli scattered throughout the specimen, and advanced diagnostic combining FISH labeling of M. tuberculosis provided more specific detection and immunolabelling of macrophages: indeed, FISH, incorporating probes demonstrated to be specific for M. tuberculosis, ensures specificity of the identification (M. tuberculosis, in this case) over the Ziehl-Neelsen in staining all the microbes containing mycolic acid in the cell wall, and beyond [15,17].…”

Life Threatening Stridor Due to Primary Laryngeal Tuberculosis

“…Primary laryngeal tuberculosis (PLTB) without pulmonary involvement is rare and merely constitutes < 1% of extrapulmonary tuberculosis cases [4]. It is postulated that PLTB occurs as a result of the direct invasion of the larynx by inhaled mycobacteria, rather than ascending infection from the lower airways [5]. However, we reported patient presented with atypical LTB symptoms, acute respiratory distress which mimicked acute supraglottitis symptoms and denied any TB symptoms and contact.…”

“…LTB clinical appearance may also resemble a supraglottic carcinoma, therefore it is important to obtain a biopsy from the laryngeal lesion for histopathologic analysis [16] [17]. However, only 34% of HPE results of PLTB demonstrated chronic granulomatous inflammation with caseous necrosis, which is pathognomonic in TB [5].…”