Title : Laryngeal tuberculosis mimicking malignancy with hepatitis C virus co infection: Case report
Abstract:
BACKGROUND:
Laryngeal tuberculosis is rare granulomatous disease of the larynx usually considered to be the result of pulmonary tuberculosis.Involvement of the larynx is seen in <1% of patients with pulmonary tuberculosis. However, the larynx may be involved without any pulmonary involvement and it requires a high degree of clinical suspicion. It causes symptoms like hoarseness of voice, dysphagia, shortness of breath, loss of weight and appetite, usually with dry cough.Often, laryngeal tuberculosis have a diagnostic challenge because of the nonspecific complaints and physical findings especially in the immunocompromised patients. In Indian population, with history of oral habits like tobacco intake, smoking, etc., laryngeal tuberculosis mimics a malignant lesion of the larynx.
CASE PRESENTATION:
46 years old female presented with complaints of hoarseness of voice for 1 year and breathing difficulty for 3 months. Patient had evening rise of temperature, loss of appetite and weight. She is on medication for epilepsy sincechildhood. No history of prior Antituberculosis Treatment and newly diagnosed hepatitis c virus infection. No H/O smoking, alcohol intake and tobacco chewing. Basic investigations were normal. Bilateral level IB cervical lymphadenopathy were present. Anti HCV were positive. Indirect laryngoscopy shows reddish proliferative growth in epiglottis extending to bilateral false vocal cord, edematous bilateral ariepiglottic fold and arytenoid. CECT neck shows diffuse circumferential minimally enhancing thickening involving supraglottic and glottic airway with narrowing and retained secretion in subglottic airway and bilateral level Ib,II,Va lymph node enlargement present. Chest X RAY and CT chest shows normal study. CT brain shows multiple granuloma at left parietal lobe present. Inview of worsening symptoms emergency Tracheostomy was done.
DIAGNOSIS:
Microlaryngeal examination and biopsy done which revealed epitheloid cell granuloma with histiocytes, langhans giant cells rimmed by lymphocytes and necroinflammtory exudates with Inflammatory granulation tissue were present. Biopsy specimen was sent for Gene Xpert and Mycobacterium Tuberculosis was detected in low levels with Rifampicin sensitivity.
CONCLUSION:
Based on Histopathology and Gene Xpert report, patient was started on Anti tubercular drugs with 4 fixed drug combination. Patient is under follow up for 2 months. Therefore Laryngeal tuberculosis should be considered in the differential diagnosis of patients with hoarseness with or without pulmonary involvement in endemic regions of tuberculosis.
