CHEST Guidelines-A-51-Year-Old-Man-With-Hoarseness-of-Voice

A-51-Year-Old-Man-With-Hoarseness-of-Voice_chest

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A 51-year-old man from the Dominican Republic, residing in New York City, sought medical attention for progressive hoarseness lasting four months. He was a lifelong nonsmoker, reported no alcohol use, and had no significant medical history. Upon examination, his vital signs were normal, but a hoarse voice was noted without any oral lesions or neck lymphadenopathy. The direct laryngoscopy revealed a suspicious lesion on the right vocal cord, prompting a biopsy. A chest radiograph showed an opacity in the right upper lung lobe, with a CT scan indicating a curvilinear opacity with central calcification in the same area. Although initial sputum cultures were negative for bacteria and acid-fast bacilli, bronchoscopy with bronchoalveolar lavage was performed, and the lavage culture eventually grew Mycobacterium tuberculosis.<br /><br />The patient's diagnosis was laryngeal tuberculosis (TB), a rare form of extrapulmonary TB more prevalent in immunocompromised individuals or those from high TB incidence areas. His condition progressed primarily with laryngeal symptoms rather than the more common respiratory symptoms linked to pulmonary TB. Laryngeal TB's presentation can mimic malignancy, with symptoms like hoarseness and odynophagia. Diagnosis is generally confirmed through biopsy and culture, both critical for excluding other conditions like laryngeal cancer.<br /><br />The patient was started on a conventional antitubercular regimen consisting of rifampin, isoniazid, pyrazinamide, and ethambutol, later narrowing to rifampin and isoniazid after confirming the TB diagnosis. After six months of treatment, his symptoms improved significantly, but he still showed signs consistent with laryngopharyngeal reflux. This case highlights the importance of considering laryngeal TB in endemic populations or those with travel history to TB hotspots, alongside continued monitoring for airway complications post-treatment.

Keywords

laryngeal tuberculosis

extrapulmonary TB

hoarseness

Mycobacterium tuberculosis

biopsy

antitubercular regimen

rifampin

isoniazid

laryngeal cancer

immunocompromised