Unusual location of tuberculosis: laryngeal form

Abstract

Introduction: Tuberculosis is a specific infectious disease caused by a mycobacterium: Koch's bacillus.
In Morocco, the lung’s lesion is the most common site 52%, however lymph node tuberculosis is the
most frequent extrapulmonary form. Laryngeal tuberculosis is rare. We present the case of a young
man with a laryngeal location.
Presentation of case: A 25-years-old young man, with 10-years history of alcohol and smoking
consumption, was presented to our ENT department with a permanent dysphonia and dyspnea
on exertion, the patient had fever and weight loss estimated to 15 kg. Clinical examination
found a cachectic patient with a 38.5 ° C of temperature, without any palpable cervical mass
or lymphadenopathy. A nasofibroscopy was performed showing a right vocal cord’s lesion. We
performed a cervical CT scan revealing a process of the glottic and supraglottic level. Direct
laryngoscopy was performed, objectifying ulcerative mass budding from the right vocal cord.
Histopathological examination revealed a tuberculoid granuloma without caseating necrosis.
Discussion and conclusion: Laryngeal tuberculosis is a rare and frequently under-recognized disease.
It typically affects adults in the fifth decade. Literature reports dysphonia to be the most common
symptom, followed by weight loss, cough, dysphagia, and odynophagia. Direct laryngoscopy allows
direct visualization of the endolaryngeal lesions and performing multiple biopsies. Histopathological
examination may identify granulomatous inflammation, caseating granulomas, and acid fast
bacillus. However, the presence of pseudoepitheliomatous hyperplasia, which mimics squamous
cell carcinoma, can make the diagnosis difficult. The pharmacologic treatment is the same as for the
pulmonary forms, and results are generally excellent. Surgical intervention is reserved for those cases
of airway compromise.