Laryngeal Tuberculosis Mimicking Laryngeal Carcinoma: A Case Report

Abstract

Laryngeal tuberculosis (LTB) is a rare form of extrapulmonary tuberculosis that can clinically and radiologically resemble laryngeal carcinoma, leading to potential misdiagnosis. We report the case of a 53-year-old man with a history of chronic smoking, no known tuberculosis or BCG vaccination, who presented with progressive dyspnea, dysphonia, and significant weight loss. Laryngoscopy revealed ulcerative lesions involving the anterior commissure, right ventricular strip, arytenoid fold, and epiglottis. CT imaging suggested malignancy, but a biopsy confirmed LTB with pulmonary involvement. The patient responded favorably to anti-tuberculous therapy, with near-complete resolution after two months. This case highlights the diagnostic challenge of differentiating LTB from malignancy. Awareness of this rare presentation is essential, especially in tuberculosis (TB)-endemic regions, to avoid unnecessary surgical intervention and ensure prompt medical treatment.

Keywords: caseating granuloma; contrast-enhanced ct; laryngeal carcinoma; laryngeal tuberculosis; mycobacterium tuberculosis.

Figure 1. Axial CECT neck – right arytenoid fold thickening

Axial contrast-enhanced CT image of the neck showing thickening of the right arytenoid fold, without associated cervical lymphadenopathy (blue arrow). CECT: Computed tomography with contrast

Figure 2. Axial CECT neck – right piriform sinus involvement

Axial contrast-enhanced CT demonstrating soft tissue thickening and partial obliteration of the right piriform sinus (blue arrow). CECT: Computed tomography with contrast

Figure 3. Coronal CECT neck – paraglottic space infiltration

Coronal CT image of the neck showing asymmetry of the laryngeal structures with effacement and infiltration of the right paraglottic fat plane (blue arrow). CECT: Computed tomography with contrast

Figure 4. Sagittal CECT neck – supraglottic extension

Sagittal contrast-enhanced CT showing cranio-caudal thickening of the supraglottic mucosa, involving the epiglottis and aryepiglottic folds, suggestive of an infiltrative lesion (blue arrow). CECT: Computed tomography with contrast

Figure 5. Axial chest CT – bilateral pulmonary nodules

Axial chest CT (lung window) showing multiple bilateral pulmonary nodules, including cavitary lesions with spiculated margins (blue arrow), as well as branching micronodules exhibiting a tree-in-bud pattern (orange arrow), suggestive of endobronchial spread.

Figure 6. Coronal chest CT – distribution of pulmonary lesions

Coronal chest CT (lung window) showing bilateral pulmonary nodules predominantly in the upper lobes, with irregular and spiculated margins (blue arrow).

Figure 7. H&E stain, x40

Histopathological section showing a well-formed epithelioid granuloma with central caseous necrosis (blue arrow), characteristic of laryngeal tuberculosis. The preserved mucosal architecture helps distinguish it from invasive carcinoma.

Figure 8. H&E stain, x200

Histological image showing multiple well-formed epithelioid granulomas (blue arrows) surrounded by lymphocytic infiltration, consistent with laryngeal tuberculosis. No evidence of cellular atypia is observed, helping to differentiate from malignant lesions.