Title : Vocal cord tuberculosis: Case report
Laryngeal tuberculosis is rare and its diagnosis requires a high degree of clinical suspicion. Involvement of the larynx is seen in <1% of patients with pulmonary tuberculosis. Patients usually present with hoarseness of voice or dysphagia and other nonspecific constitutional symptoms like fever or localized pain. Here, we present a case of vocal cord tuberculosis.
Involvement of larynx in tuberculosis occurs as secondary to pulmonary tuberculosis. Primary involvement of larynx is rare. Exact mode of transmission from the lungs is not known. It is believed that contact with sputum containing tubercle bacilli plays an important role. Lesions vary from erythema to ulceration and masses resembling carcinoma. Direct laryngoscopy and biopsy are mandatory to establish a definitive diagnosis.
46 years old male patient case came with complaints of hoarseness of voice for 3 months, H/o loss of weight present. No other constitutional symptoms. H/O Prior Pulmonary Tuberculosis 6 years back ,took antitubercular treatment for 6 months. Now Basic investigations were normal. Chest X ray normal. Videolaryngoscopy shows hyperemic, oedematous and thickened right vocal cord seen. Biopsy shows granuloma composed of epithelial histiocytes, lymphocytes, multinucleated gaint cell and necrosis evident . Mantoux test positive 22mm. Patient started on antitubercular treatment. The follow up after treatment showed resolution of the symptoms and improvement of the lesion.
Laryngeal tuberculosis is a granulomatous disease of the larynx and usually been results from pulmonary tuberculosis. Laryngeal involvement develops most commonly secondary to bronchogenic, hematogenous, or lymphatic spread from advanced pulmonary disease. Primary laryngeal tuberculosis without pulmonary disease is much less common and is presumed to arise from direct invasion of the larynx via inhalation. The most common sites of laryngeal involvement are the epiglottis, true vocal cords, and false vocal cords, although the disease can be trans-spatial and affect any tissue.
In order to avoid a delay in diagnosis and management, the possibility of tuberculosis should always be entertained in patients who have traveled to endemic areas and who present with chronic hoarseness, odynophagia, and/or weight loss. However, laryngeal cancer is typically seen in older individuals and is notably an unusual diagnosis before age 40. Other granulomatous processes that can present with laryngeal involvement include granulomatosis with polyangiitis, sarcoidosis, and syphilis. Laryngeal tuberculosis may be categorized to ulcerative lesions, nonspecific inflammatory lesions, polypoid lesions and ulcerofungative mass lesions.
Laryngeal tuberculosis should be considered in the differential diagnosis of patients with hoarseness with or without pulmonary involvement in endemic regions of tuberculosis and in poor socio-economic group population.