Isolated Laryngeal Tuberculosis: a Diagnostic Dilemma

Abstract

Laryngeal tuberculosis is a rare condition, isolated laryngeal tuberculosis without pulmonary manifestations is even more rare. Patients usually presents with voice change, difficulty in swallowing and other constitutional symptoms. The symptoms and findings can look like malignancy in most of the cases. Here, we present a case of primary laryngeal tuberculosis without pulmonary tuberculosis. A 24 year old man who presented to us with hoarseness of voice with 1 year duration. Laryngoscopic study showed a proliferative growth in the epiglottis, aryepiglottic folds and vocal cords and was diagnosed to have laryngeal tuberculosis on histopathology by the typical appearance of granuloma and caseous necrosis. The patient was started on standard antitubercular therapy and he had an excellent response to the same within 6 months. Isolated laryngeal tuberculosis should be suspected in patients with laryngeal complaints with no pulmonary symptoms, especially in a developing country like India where pulmonary tuberculosis is prevalent. Even though isolated laryngeal tuberculosis cases are rare, we should keep in mind the possibility of tuberculosis in the differential diagnosis of laryngeal tumors, as the incidence of tuberculosis is steadily increasing.

Keywords: Anti tubercular drugs; Larynx; Primary; Tuberculosis.

Fig. 1

Direct Laryngoscopic finding of the pale and proliferative epiglottis

Fig. 2

Direct Laryngoscopic finding of the pale and proliferative false cords

Fig. 3

Histopathological examination of sample from epiglottis (H&E 10 ×)

Fig. 4

Histopathological examination of sample from epiglottis (H&E 40 ×) showing epitheloid granuloma

Fig. 5

Histopathological examination of sample from epiglottis (H&E 40×) showing Langhan’s type of giant cells