2018 Volume 30 Issue 1 Pages 13-17
We herein report two cases of laryngeal tuberculosis.
Case 1: A 61-year-old woman presented to our clinic with a chief complaint of hoarseness for 2 months. She had no history of tuberculosis. Based on her subjective symptoms and the findings on laryngeal fiberscopy, a laryngeal granuloma induced by gastroesophageal reflux was suspected. Since her symptoms and laryngeal findings did not improve on treatment with a proton pump inhibitor for one month, she was hospitalized to undergo laryngeal granuloma resection. A pre-operative chest X-ray revealed abnormal lung shadows suggestive of pulmonary tuberculosis. A polymerase chain reaction (PCR) examination was positive for Mycobacterium tuberculosis DNA. A diagnosis of pulmonary tuberculosis was confirmed.
Case 2: An 87-year-old man presented to our clinic with a chief complaint of coughing. He did not report a history of tuberculosis. Based on the findings on laryngeal fiberscopy, we initially suspected bacterial laryngitis or a laryngeal tumor. His symptoms and laryngeal findings did not improve on treatment with antibiotics for 11 days. Since we had already encountered Case 1, we ordered a chest X-ray study and a bacteriological examination under suspicion of laryngeal tuberculosis. The patient’s chest X-ray showed evidence of pulmonary tuberculosis, and a diagnosis of pulmonary tuberculosis was confirmed by a positive PCR finding of Mycobacterium tuberculosis DNA.
Based on these two cases, we propose the following algorithm: When a patient presents with symptoms and findings on laryngeal fiberscopy making it difficult to determine whether it is a laryngeal tumor or laryngitis, we should initially perform conservative treatment with drugs. If symptoms do not improve, a diagnosis of laryngeal tuberculosis should be suspected. In such cases, for the early diagnosis and to prevent the further spread of infection, we should perform an imaging study such as chest X-ray, and a bacteriological examination before performing a biopsy in order to rule out a laryngeal tumor.