Primary laryngeal tuberculosis-“The great masquerader”

Abstract

We report a case of primary laryngeal tuberculosis in a 54 year old Indian male, who had hoarseness as his presenting complaint. This case highlights that laryngeal tuberculosis may occur even without pulmonary tuberculosis, and the characteristics of the lesions now appear to be more nonspecific than earlier. Otolaryngologists and airway physicians need to be more alert to the emergence of laryngeal tuberculosis with atypical clinical manifestations and consider it in their differential diagnosis of all laryngeal diseases.

Dysphagia as the Presenting Symptom of Laryngeal Tuberculosis

“…Common complaints in patients with laryngeal TB include hoarseness, odynophagia, dysphagia, weight loss, and cough [4,[7][8][9]. On presentation, many of these cases are evaluated for a malignancy workup.…”

“…Many patients, like our patient, also end up undergoing upper endoscopy to further evaluate complaints of dysphagia and odynophagia. When they finally have a laryngoscopy, they are discovered to have ulcerations or growths on the vocal cords, which, when biopsied, reveal the diagnosis of TB [4][5][7][8][9]. Interestingly, these masses can be treated with, and respond favorably to (i.e., no surgical intervention is necessary unless stenosis is present), standard of care anti-TB therapies in areas where strains are not resistant [4][5][7][8][9].…”

“…In earlier times, laryngeal TB was a prevalent presentation, occurring in anywhere from 35%-83% of cases based on autopsy results [ 4 ]. The prevalence of laryngeal TB, representing approximately 1% of TB cases in modern times, has been declining in North America, though it is suspected that missed diagnosis and under-reporting may play a role in this trend [ 4 , 7 ].…”

“…Despite being a rare presentation in modern times, laryngeal TB is one of the commonest causes of granulomatous lesions of the larynx [ 7 ]. Laryngeal TB can present as a primary lesion or a secondary lesion, depending on various modes of pathogenesis [ 4 - 5 , 7 - 8 ]. Primary lesions occur through the direct spread of bacilli into the larynx.…”

A Case of Laryngeal Tuberculosis Mimicking Lymphoma

“…Laryngeal tuberculosis (TB) is rare, and requires a high degree of clinical suspicion to make the diagnosis. However, the incidence of laryngeal TB has steadily increased due to rising prevalence of HIV infection, immunosuppressive diseases and treatments, and the emergence of resistant organisms and atypical mycobacteria [ 1 ]. Delay in diagnosis of primary laryngeal TB poses a serious threat to the patient due to delayed treatment and further complications.…”