Rare differential diagnosis: laryngeal tuberculosis

Introduction:

Tuberculosis (TB) usually affects the lungs, but can also occur in other organs. About 2% of extra-pulmonary Tbc occurs in the area of the larynx. From solitary masses to extensive occurrence, there are various forms.

Methods:

We were introduced to a 22-year-old patient of Romanian descent who had given birth a few days earlier. In case of suspected upper respiratory tract infection with odynophagia, cough and dysphonia, she got a treatment with Amoxicillin 3 × 1 g p.o.. There had been a marked progression with dyspnea and stridor. Massively edematous aryepiglottic folds with fibrinous, reddened epiglottis were seen. The mucosa of the glottis was also edematously altered and fibrin-occupied. In cases of suspected laryngitis with abscessed epiglottis and restricted breathing, the indication for surgical repair and protection of the respiratory tract was made.

Results:

Intraoperatively, cloudy secretions were discharged from the epiglottis. The ulcerations were biopsied and sent for microbiological and histopathological examination. The patient was transferred intubated to the intensive care unit. The differential diagnosis Tbc was confirmed on the following day by auramine staining and PCR. Together with the colleagues of the infectiology a therapy with Isoniazid, Ethambutol, Rifampicin and Pyrazinamide was initiated. Due to the extensive infestation, the temporary tracheostomy was performed. It showed a clear regredienz in the course, so that the tracheostomy could be closed again after six weeks.

Discussion:

Although laryngeal tuberculosis is a rarity in this country, it should always be considered in cases of unclear laryngeal lesions.

Publication History

Publication Date:
23 April 2019 (online)