QJM: An International Journal of Medicine, 2017, 521
doi: 10.1093/qjmed/hcx078
CLINICAL PICTURE
Laryngeal tuberculosis: a forgotten disease
A 93-year-old woman presented with a 2-month history of
hoarseness and cough. The patient had never received immu-
nosuppressive treatment, was serologically negative for HIV
and hepatitis, and did not have a family history of tuberculosis.
Laryngoscopy showed an ulcerated and granular lesion in the
ventricular folds, larynx vestibule and bilateral vocal cords
(Figure 1A). Histological analysis of the biopsy specimen
revealed granulomas with caseating necrotic centers and
Langhans giant cells without carcinoma. Ziehl-Neelsen staining
of the bronchoalveolar lavage fluid revealed acid-fast bacilli and
PCR using the fluid revealed Mycobacterium tuberculosis. High-
resolution chest computed tomography showed micronodular
lesions in the right lung and a lesion suggestive of tuberculosis
in the apex (Figure 1B). The patient received a standard 6-month
anti-tuberculous treatment (rifampicin, isoniazid, pyrazina-
mide, and ethambutol). Tuberculosis is an infectious disease
that is caused by M. tuberculosis. Although laryngeal tuberculosis
only accounts for 1% of all tuberculosis cases, laryngeal tuber-
culosis is terrific contagious.1 Laryngeal tuberculosis has been
considered to be the result of extra-pulmonary manifestations,
and has often been associated with pulmonary tuberculosis.
Thus, laryngeal tuberculosis should be suspected in all patients
with chronic cough, hoarseness and significant dysphagia. The
symptoms are often limited, although the diagnosis can be con-
firmed using adequate diagnostic and radiographic examina-
tions. Tuberculosis has become a rare disease in the developed
Figure 1. (A) Laryngoscopic picture showing an ulcerated and granular lesion in the ventricular folds, larynx vestibule and bilateral vocal cords. (B) High-resolution
chest computed tomography showing micronodular lesions in the upper lobe of the right lung.
C The Author 2017. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved.
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Clinical picture
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countries, but tuberculosis infections began increasing in 1985,
partly because of the HIV/AIDS emerging. Also, the rise in drug-
resistant tuberculosis and the outbreaks of multidrug resistant
tuberculosis are serious underlying problems in the health-care
infrastructure all over the world.2 Early identification can facili-
tate appropriate management and treatment, which can reduce
the prevalence of tuberculosis and improve public health.
Photographs and text from: H. Matsuura and Y. Yamaji, Mitoyo
General Hospital, 708, Himehama, Toyohama-cho, Kanonji City,
Kagawa 769-1695, Japan. email: superonewex0506@yahoo.co.jp
Conflict of interest: None declared.
References
1. Tostmann A, Kik SV, Kalisvaart NA, Sebek MM, Verver S,
Boeree MJ, et al. Tuberculosis transmission by patients with
smear-negative pulmonary tuberculosis in a large cohort in
the Netherlands. Clin Infect Dis 2008; 47:1135–42.
2. Marks SM, Flood J, Seaworth B, Hirsch-Moverman Y,
Armstrong L, Mase S, et al. Treatment practices, outcomes, and
costs of multidrug-resistant and extensively drug-resistant
tuberculosis, United States, 2005–2007. Emerg Infect Dis 2014;
20:812–21.
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