RESUMO
@#Tuberculous laryngitis was considered common during pre-antibiotic area but after the effective antitubercular medication, the incidence of laryngeal tuberculosis had decreased to less than one percent2. Clinical presentation is mostly unclear but usually presents with odynophagia, cough, hoarseness of voice and frequently confused with other diseases, more importantly fungal laryngitis. This is a case of a diagnostic dilemma of an immunocompetent 55-year-old male presenting with odynophagia, dysphagia and hoarseness of voice that was initially managed as a case of fungal laryngitis due to history of prolonged use of dexamethasone and findings of leukoplakia in laryngoscopy. Despite adequate time for treatment, no significant improvement was noted. Acid fast bacilli microscopy tested negative. A previous history of pulmonary tuberculosis treatment and chest radiographs revealing fibrosis on both upper lungs puts tuberculous laryngitis as one of the differentials. Sputum GeneXpert/RIF taken and tested positive, hence lead to the diagnosis of tuberculous laryngitis. Guideline-based quadruple anti-tubercular therapy started and had showed a positive response. Laryngeal tuberculosis (LTB) requires a high index of suspicion since it mimics various laryngeal diseases such as fungal laryngitis or malignancy. Clinicians should always be aware of the atypical clinical features of laryngeal tuberculosis and the possibility of primary laryngeal tuberculosis, for early diagnosis and prompt treatment, thus preventing morbid complications. A positive mycobacterial culture along with a typical histopathological appearance remain the cornerstone of diagnosis, but sputum AFB in microscopy and GeneXpert/RIF must not be ignored as these can be cost-effective diagnostic alternatives.