Laryngeal tuberculosis: a forgotten disease

Abstract

A 93-year-old woman presented with a 2-month history of hoarseness and cough. The patient had never received immunosuppressive treatment, was serologically negative for HIV and hepatitis, and did not have a family history of tuberculosis. Laryngoscopy showed an ulcerated and granular lesion in the ventricular folds, larynx vestibule and bilateral vocal cords (Figure 1A). Histological analysis of the biopsy specimen revealed granulomas with caseating necrotic centers and Langhans giant cells without carcinoma. Ziehl-Neelsen staining of the bronchoalveolar lavage fluid revealed acid-fast bacilli and PCR using the fluid revealed Mycobacterium tuberculosis. High-resolution chest computed tomography showed micronodular lesions in the right lung and a lesion suggestive of tuberculosis in the apex (Figure 1B). The patient received a standard 6-month anti-tuberculous treatment (rifampicin, isoniazid, pyrazinamide, and ethambutol). Tuberculosis is an infectious disease that is caused by M.tuberculosis. Although laryngeal tuberculosis only accounts for ∼1% of all tuberculosis cases, laryngeal tuberculosis is terrific contagious.1 Laryngeal tuberculosis has been considered to be the result of extra-pulmonary manifestations, and has often been associated with pulmonary tuberculosis. Thus, laryngeal tuberculosis should be suspected in all patients with chronic cough, hoarseness and significant dysphagia. The symptoms are often limited, although the diagnosis can be confirmed using adequate diagnostic and radiographic examinations. Tuberculosis has become a rare disease in the developed countries, but tuberculosis infections began increasing in 1985, partly because of the HIV/AIDS emerging. Also, the rise in drug-resistant tuberculosis and the outbreaks of multidrug resistant tuberculosis are serious underlying problems in the health-care infrastructure all over the world.2 Early identification can facilitate appropriate management and treatment, which can reduce the prevalence of tuberculosis and improve public health.