Laryngeal tuberculosis presenting as a supraglottic carcinoma: a case report and review of the literature

Abstract

Introduction: Laryngeal tuberculosis used to be a common complication in advanced pulmonary tuberculosis. However, it has become a rare occurrence in developed countries since the introduction of antituberculous agents. Moreover, the pattern of the disease has changed over the years. Nowadays, it more closely resembles a laryngeal carcinoma than any other laryngeal illness.

Case presentation: We describe the case of a 50-year-old Caucasian man who presented with the clinical picture of laryngeal cancer, but which turned out to be tuberculosis. We illustrate the difficulty of recognizing laryngeal tuberculosis both clinically and even with radiological examination.

Conclusion: Although laryngeal tuberculosis is uncommon, especially in developed countries, it still occurs and should be considered as a differential diagnosis in any laryngeal disease, in particular in the case of a laryngeal carcinoma.

Figure 1

TB incidence per 100,000 inhabitants for developed, developing and underdeveloped countries in the past decade. Based on the Human Development Index (HDI) and tuberculosis (TB) incidence per country between 1997 and 2007 [1]. The graph summarizes data of 172 countries: 73 developed countries (HDI >0.8), 73 developing countries (HDI 0.5-0.8) and 26 underdeveloped countries (HDI <0.5).

Figure 2

Radiography. (A) Initial antero-posterior chest X-ray. Miliary nodules predominantly bilaterally distributed in the upper parts of the lung parenchyma. (B) Axial contrast-enhanced computed tomography image of the neck: enhanced mass (arrows) in the false vocal cord which extends into the anterior commissure and obliteration of the paraglottic fat (arrowhead). (C) Axial high resolution computed tomography image of the chest: diffusely distributed interstitial nodular alterations with formation of central cavities (arrows).

Figure 3

Biopsy histology. (A) Necrotising granulomatous inflammation: granuloma on the left and necrosis on the right side of the image. (B) Red stained Mycobacterium tuberculosis in Ziehl-Neelsen acid fast stain. (C) Granuloma with a multinucleated giant cell in the center (left side of image). (D) Overview of a necrotising granulomatous inflammation: granulomas on the left side and necrosis on the right.