Life-Threatening Stridor due to Laryngeal Tuberculosis in the COVID-19 Era: Report of a Case

Laryngeal tuberculosis is the most frequent granulomatous disease of the larynx and it is prone to be diagnosed as cancer. COVID-19 pandemic caused considerable disruption in tuberculosis service provisions both in the primary care and hospital settings. This report describes a rare case of life-threatening stridor in a patient who presented with an ulceroproliferative laryngeal mass later confirmed as laryngeal tuberculosis. Urgent tracheostomy was performed. The patient’s sputum and the computed tomography of the chest revealed a pulmonary, as well as laryngeal tuberculosis. The patient was commenced on a 24 week course of anti-tuberculous treatment which was interrupted because of a mild course of hospital-acquired coronavirus infection. 3 months after initial treatment for tuberculosis, his sputum cultures became negative. Flexible laryngoscopy was performed at our department 4 months after commencement of treatment, demonstrating complete regression of the lesion and symmetrical laryngeal mobility, hence the patient was successfully decannulated and discharged to be followed up to his community hospital. In the time of COVID-19 pandemic, we should never underestimate other severe infectious diseases.

Unusual location of tuberculosis: laryngeal form

Introduction: Tuberculosis is a specific infectious disease caused by a mycobacterium: Koch's bacillus. In Morocco, the lung’s lesion is the most common site 52%, however lymph node tuberculosis is the most frequent extrapulmonary form. Laryngeal tuberculosis is rare. We present the case of a young man with a laryngeal location. Presentation of case: A 25-years-old young man, with 10-years history of alcohol and smoking consumption, was presented to our ENT department with a permanent dysphonia and dyspnea on exertion, the patient had fever and weight loss estimated to 15 kg. Clinical examination found a cachectic patient with a 38.5 ° C of temperature, without any palpable cervical mass or lymphadenopathy. A nasofibroscopy was performed showing a right vocal cord’s lesion. We performed a cervical CT scan revealing a process of the glottic and supraglottic level. Direct laryngoscopy was performed, objectifying ulcerative mass budding from the right vocal cord. Histopathological examination revealed a tuberculoid granuloma without caseating necrosis. Discussion and conclusion: Laryngeal tuberculosis is a rare and frequently under-recognized disease. It typically affects adults in the fifth decade. Literature reports dysphonia to be the most common symptom, followed by weight loss, cough, dysphagia, and odynophagia. Direct laryngoscopy allows direct visualization of the endolaryngeal lesions and performing multiple biopsies. Histopathological examination may identify granulomatous inflammation, caseating granulomas, and acid fast bacillus. However, the presence of pseudoepitheliomatous hyperplasia, which mimics squamous cell carcinoma, can make the diagnosis difficult. The pharmacologic treatment is the same as for the pulmonary forms, and results are generally excellent. Surgical intervention is reserved for those cases of airway compromise.

Bifocal Tuberculosis with Adalimumab Revealed by Laryngeal Involvement: Case Report

Introduction. Anti-TNF treatment has transformed the treatment of chronic inflammatory rheumatism. Although the therapy can be highly effective, anti-TNF drugs are associated with an increased risk of tuberculosis, especially extra-pulmonary tuberculosis. Laryngeal tuberculosis is rare and its symptoms are not specific. Laryngeal tuberculosis is often secondary to another localization, particularly pulmonary. In the use of anti-TNF therapy, its development is unusual. Case report. We report a case of bifocal tuberculosis: laryngeal and pulmonary tuberculosis revealed by laryngeal involvement in a patient aged 41 years with axial spondylarthritis treated with Adalimumab. Conclusion. This presentation highlights the importance to consider the rare possibility of laryngeal tuberculosis in the presence of atypical otorhinolaryngologic signs under anti-TNF therapy and underlines the importance of looking for other tuberculosis involvement.