Laryngeal tuberculosis: not the usual suspect
| Autor: | I Street, D Gillett, J Weighill, A Sawyer |
|---|---|
| Rok vydání: | 2006 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.diagnostic_test Laryngeal tuberculosis business.industry Laryngoscopy Antitubercular Agents General Medicine Surgery Diagnosis Differential Tuberculosis Laryngeal Erythrocyte sedimentation rate Biopsy otorhinolaryngologic diseases medicine Humans Outpatient clinic Blood test Drug Therapy Combination No fixed abode Supraglottis Tomography X-Ray Computed business Tuberculosis Pulmonary |
| Zdroj: | Scopus-Elsevier |
| ISSN: | 1759-7390 1750-8460 |
| DOI: | 10.12968/hmed.2006.67.4.20873 |
| Popis: | A 40-year-old Caucasian male patient of Irish origin residing in Brighton and of no fixed abode presented to the ear nose and throat outpatient clinic with dysphonia and dyspnoea for approximately 3 months. He consumed about 110 units of alcohol per week and smoked about 40 cigarettes each day. On examination, he had two palpable nodes in the right posterior triangle. Flexible nasal endoscopy showed an immobile left vocal cord and a transglottic mass. A chest X-ray resulted in a picture consistent with infection, although metastases could not be excluded (Figure 1). Blood test results showed a normal white cell count and an erythrocyte sedimentation rate of 118. Eleven days later, laryngoscopy and biopsy from the left supraglottis was performed; a mass with an irregular surface and without ulceration was noted over the left arytenoid cartilage and false cord. After 4 days a staging computed tomography (CT) scan of the neck and chest was done. The patient was seen in the outpatient clinic within 2 weeks: histology showed only mild subepithelial chronic inflammation; no specific mention of granulomata was made. The CT scan showed extensive cervical lymphadenopathy, the lungs showed multiple poorly defined soft tissue lesions with cavitation consistent with multiple metastases, while laryngeal appearances were consistent with a T2/T3 supraglottic lesion (Figure 2). The possibility of pulmonary tuberculosis was realized. The respiratory physicians reviewed his chest CT and, on further questioning, he had no history of intravenous drug abuse or other risk factors for immunodeficiency. Human immunodeficiency virus testing was not performed. A repeat biopsy was arranged the next day to search for acid-fast bacilli. However, this was cancelled preoperatively because the patient was dyspnoeic and had a pyrexia of 38°C. The next morning, his sputum sample showed acid-fast bacilli. The patient was isolated and started on once-daily doses of rifampicin, isoniazid, pyrazinamide and ethambutal. These were given as a 6-month course consisting of 2 months of treatment with the four drugs, followed by a 4-month period of daily treatment with isoniazid and rifampicin. The patient remained as an inpatient under the care of the respiratory medicine department for 2 weeks and improved on the antituberculous medication regimen – at that point, he went to theatre for a repeat laryngoscopy and biopsy. This was taken from the left arytenoid region, where a defined mass was noted. His next appointment was less than a fortnight later in the outpatient clinic. The histology report showed that there was only chronic inflammation; there were no acid-fast bacilli on staining and no granulomata were seen. The original biopsy specimen was re-examined and stained with a view to finding acid-fast bacilli, which were definitively identified within the laryngeal tissue. On longer-term follow-up, he was seen in clinic 3 months later. His voice had improved, his vocal folds were moving normally and the left arytenoid mass was no longer present. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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