Laryngeal tuberculosis - a rare tuberculosis manifestation as differential diagnosis of a laryngocele

A 27-year-old man of Indian descent was introduced with a suspected diagnosis of a branchial cyst. A slowely growing swelling on the paralaryngeal right showed laryngoscopically a protrusion of the right vestibular fold as well as a redness and edematous distention of the right vocal cord, which still retained its normal mobility. Sonographically, a hypoechoic process, growing up to the endolyngeal space and accompanying with an increased calcification of the thyroid cartilage, was observed. Based on the clinical findings, the differential diagnosis of a combined laryngocele was considered. Upon specific request, the patient reported on coughing and pain in the right thorax as well as an unwanted weight loss of 10 kg within the last few months. After puncture, M. tuberculosis complex DNA was detected by PCR. Computer tomography of the thorax and bronchoskopy with bronchial alveolar lavage confirmed the suspicion of simultaneously open pulmonary tuberculosis. Due to genotypically proven Rifampicin resistance the tuberculostatic therapy started with second-line therapy.

In rare laryngeal tuberculosis, an endoscopically uncharacteristic picture often appears. Frequently it is associated with open pulmonary tuberculosis. Doctors, nursing staff and fellow patients are thereby exposed to a high risk of infection. Approximately 3% of all newly diagnosed tuberculosis cases show multidrug resistance. In case of clinical suspicion of a lateral branchial cyst or laryngocele, laryngeal tuberculosis should always be considered, especially in patients with origin from high-risk countries, precisely because an operative procedure can thus be avoided.

Publication History

Publication Date:
23 April 2019 (online)