Tuberculosis of the epiglottis: a case report

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

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.

Primary Laryngeal Tuberculosis: Our Experiences at a Tertiary Care Teaching Hospital in Eastern India

INTRODUCTION

Primary laryngeal tuberculosis is a chronic bacterial infection of the larynx by Mycobacterium tuberculosis without affecting the lungs. It is a rare type of extrapulmonary tuberculosis seen in clinical practice.

OBJECTIVES

This study aimed to evaluate the clinical presentation, diagnosis, and treatment of primary laryngeal tuberculosis at a tertiary care teaching hospital in eastern India.

MATERIALS AND METHODS

This is a retrospective study of 11 cases of primary laryngeal tuberculosis managed between December 2013 and January 2018. The detailed clinical presentations, investigations, and treatment of primary laryngeal tuberculosis of the patients were studied.

RESULTS

Primary laryngeal tuberculosis is common in men with mean age of 38.63 years. Hoarseness of the voice is the most common symptom, and the most common site for primary laryngeal tuberculosis is the vocal fold with ulcerative lesion. Endoscopic examinations of the larynx in laryngeal tuberculosis are nonspecific and are to be confused with laryngeal cancer. Histopathological and bacteriological examinations are confirmatory tests for the diagnosis. After confirmation of the diagnosis, all patients had taken antitubercular therapy for 6 months, which gave excellent outcome.

CONCLUSIONS

Delayed diagnosis or untreatable laryngeal tuberculosis will lead to high morbidity and mortality of the patient. Although primary laryngeal tuberculosis has nonspecific clinical presentations, it is very important to have a high index of suspiciousness to rule out tubercular lesion in the larynx as this disease is curable.

Primary tuberculosis of upper airway: case report of 3 rare presentation

Tuberculosis of the upper airway is usually seen in conjunction with primary pulmonary tuberculosis. Primary tuberculosis of this area without involvement of the lung is very rare and often mistaken for malignancies. We report here three patients (2 male & 1 female) who presented with different symptoms and on investigations revealed to be suffering from tuberculosis of the upper airway (nasopharynx, tonsil & epiglottis). Further investigations revealed that no other area was involved. All the patients were started on standard anti tubercular therapy and showed complete cure on completion of therapy.

Case Report: Acute tuberculous laryngitis presenting as acute epiglottitis

The incidence of laryngeal tuberculosis (TB), which had dropped dramatically after the institution of modern anti-TB chemotherapy, has shown recent reemergence. It is important to be aware of its possibility, especially as it can present with nonspecific upper airway symptoms and a frequent lack of constitutional manifestations. We report such a case presenting as acute epiglottitis, with diffuse involvement of the supraglottic larynx associated with reactivation lung TB.

An uncommon shape of epiglottis misleading as acute epiglottitis

We report a case of a 31-year-old Japanese woman with an uncommon shape of epiglottis misleading as acute epiglottitis. She presented with high fever, arthralgia, general fatigue and strong throat pain. Laryngeal fiberscopy showed a markedly swollen epiglottis suggestive of acute epiglottitis, though she had no signs of asphyxia. A careful observation and detailed medical history ruled out acute epiglottitis. However, without clinical discretion, it might have been misinterpreted as acute epiglottitis. She was diagnosed later with Behçet's disease, which is reported to present pharyngeal stenosis. Two years later, a repeat laryngeal fiberscopy showed exactly the same appearance of the epiglottis, suggesting its shape to be permanent. The cause of this misleading shape of the epiglottis in this patient is yet unknown. For similar cases, a possibility of this kind of epiglottis should be considered before diagnosing as acute epiglottitis.