Rare Diagnosis: Laryngeal Tuberculosis Mimics Common Voice Issues
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A 47-year-old man experiencing persistent hoarseness was unexpectedly diagnosed with laryngeal tuberculosis (TB), a rare presentation of the disease frequently enough mistaken for more common conditions like acid reflux or vocal strain. The case, detailed in a recent report, highlights the importance of considering TB in the differential diagnosis of chronic dysphonia, even in the absence of typical TB symptoms.
The patient initially presented with a six-month history of progressive voice changes, including hoarseness and a sensation of a lump in his throat. He had previously been evaluated for gastroesophageal reflux disease (GERD) and treated with proton pump inhibitors, but his symptoms did not improve. This initial misdirection is common, as the symptoms of laryngeal TB can closely resemble those of benign vocal cord lesions or upper respiratory infections.
The Diagnostic Challenge of Laryngeal TB
The patient’s lack of response to GERD treatment prompted further inquiry.A laryngoscopy revealed ulcerative lesions on his vocal cords, raising suspicion of malignancy. Though, biopsies were negative for cancer. “The initial presentation was atypical, leading clinicians down a path of considering more common causes of dysphonia,†a senior medical official stated.
further testing, including a tuberculin skin test (TST) and interferon-gamma release assay (IGRA), came back positive. Subsequent cultures of laryngeal secretions confirmed the presence of Mycobacterium tuberculosis, the bacteria that causes TB.This confirmed the diagnosis of laryngeal TB, a form of extrapulmonary TB affecting less than 1% of all TB cases globally.
Understanding the Disease and its Presentation
Tuberculosis is typically associated with lung infection, but it can spread to other parts of the body, including the larynx. Laryngeal TB can manifest in various ways, including:
- Vocal cord ulcers
- Granulomas (inflammatory masses)
- Edema (swelling)
- Hoarseness
- Dysphagia (difficulty swallowing)
The report emphasizes that the insidious onset and non-specific symptoms of laryngeal TB often lead to delayed diagnosis. The patient in this case had no known risk factors for TB, such as recent travel to endemic areas or exposure to individuals with active TB. This underscores the need for a high index of suspicion,even in low-risk populations.
Treatment and Prognosis
The patient was initiated on a standard four-drug anti-TB regimen, including isoniazid, rifampin, pyrazinamide, and ethambutol.Following six months of treatment, his symptoms resolved, and repeat laryngoscopy showed important improvement in the vocal cord lesions.
“Early diagnosis and appropriate treatment are crucial for preventing complications and ensuring a favorable outcome,†noted one analyst specializing in infectious disease. Potential complications of untreated laryngeal TB include airway obstruction, vocal cord paralysis, and even spread to other organs.
This case serves as a critical reminder for clinicians to consider laryngeal TB in the differential diagnosis of chronic dysphonia, particularly when conventional treatments fail. A thorough evaluation, including microbiological testing, is essential for accurate diagnosis and timely intervention. The rarity of the condition should not preclude its consideration, as prompt treatment can prevent significant morbidity and preserve vocal function.
