Laryngeal involvement in a patient with active postprimary tuberculosis: Case report of a rare extrapulmonary manifestation

Abstract

A 43-year-old woman was found to have active post-primary tuberculosis and a lateral neck radiograph showing a thickened epiglottis. Bronchoscopy-guided biopsies of the epiglottis and lung were acid fast bacilli stain positive. Histopathology from both showed multiple caseating granulomas. The patient's condition improved with RIPE therapy. This case illustrates the importance for physicians to be aware of possible laryngeal involvement in tuberculosis and that it can present even without evidence of active or latent tuberculosis.

Keywords: Dysphonia; Extrapulmonary tuberculosis; Laryngitis; Odynophagia; Tuberculosis.

Fig. 1

(A) Chest radiograph showing bilateral multifocal pneumonia, with large left upper lobe cavity. (B, C, D) CT scan coronal, sagittal and axial lung window showing large left lung cavitary lesion, multiple smaller cavitary lesions, multifocal patchy consolidations. (E) CT contrast enhanced scan axial mediastinal window showing cavitary lesions, consolidation. Note marked lack of subcutaneous fat representing cachexia.

Fig. 2

Lateral soft tissue neck radiograph showing a lobulated, enlarged epiglottis (white arrow).

Fig.3

Histopathology images from epiglottis. (A) Ziehl-Neelsen stain showing rod shaped magenta-colored mycobacteria. (B) H & E stain showing necrotizing granuloma; and (C) mycobacteria in the necrotizing granuloma. (Color version of figure is available online.)

Fig.4

Bronchoscopy images. (A) Distal trachea, carina showing swollen patchy pale mucosa. (B) Epiglottis showing swollen pale mucosa. (Color version of figure is available online.)