Tuberculosis pulmonar y laríngea: una forma poco frecuente de presentación en la edad pediátrica / Pulmonary and laryngeal tuberculosis: a rare presentation in pediatrics / Tuberculose pulmonar e laríngica: uma apresentação pouco frequente na idade pediátrica

Introducción: la tuberculosis (TB) es una enfermedad infectocontagiosa granulomatosa crónica, producida por Mycobacterium tuberculosis. En Uruguay se ha notificado un aumento en el número de casos, con una incidencia reportada en 2017 de 28,6/100.000 habitantes, siendo de 6,67/100.000 en menores de 15 años. La tuberculosis laríngea es una forma poco frecuente y evolucionada de tuberculosis, que suele manifestarse con disfonía crónica. Su diagnóstico requiere un alto índice de sospecha. Objetivo: describir un caso clínico de presentación poco frecuente en la edad pediátrica. Caso clínico: adolescente de 13 años, sana, vacunas vigentes, con antecedentes de conductas sexuales activas y papilomatosis laríngea diagnosticada por laringoscopía directa como causa de disfonía crónica. Consulta en emergencia por dolor abdominal, constatándose al examen clínico adelgazamiento asociado a síntomas respiratorios y síndrome tóxico bacilar asociado a disfonía crónica de cuatro meses de evolución, por lo cual se plantea tuberculosis laríngea e ingresa para estudio. Niega contacto de tuberculosis. En la radiografía de tórax se constata lesión cavernosa en vértice pulmonar izquierdo. Las baciloscopías de esputo fueron positivas (directo y cultivo) confirmando el planteo de TB pulmonar y laríngea. Se realizó tratamiento antituberculoso supervisado con excelente evolución posterior. Conclusiones: la tuberculosis es una enfermedad reemergente en nuestro país, que requiere un alto índice de sospecha. Su diagnóstico sigue siendo un desafío para los pediatras ya que la confirmación diagnóstica no siempre es posible. En este caso clínico la sospecha clínica frente a una disfonía crónica asociada a síntomas respiratorios fue fundamental para establecer el diagnóstico, a pesar de no contar con nexo epidemiológico.

Introduction: tuberculosis (TB) is an infectious, chronic granulomatous disease caused by Mycobacterium tuberculosis. An increase in the number of cases has been reported in Uruguay, with an incidence reported in 2017 of 28.6/100,000 inhabitants, being 6.67/100,000 in children under 15 years of age. Laryngeal tuberculosis is a rare and evolved form of tuberculosis, which usually shows chronic dysphonia, which requires high levels of suspicion. Objective: to describe a clinical case with a rare presentation in pediatric age. Clinical case: 13-year-old female adolescent, healthy, fully vaccinated, with a history of active sexual behaviors and laryngeal papillomatosis diagnosed by direct laryngoscopy as a cause of chronic dysphonia. The emergency consultation was caused by abdominal pain, confirming the clinical examination weight loss associated with respiratory symptoms and bacillary toxic syndrome associated with chronic dysphonia of four months of evolution, for which laryngeal tuberculosis was considered and she was admitted for screening. She denies having been in contact with tuberculosis. The chest X-ray revealed a cavernous lesion in the left pulmonary apex and sputum smears were positive (direct and culture), confirming the suggestion of pulmonary and laryngeal TB. Supervised anti-tuberculosis treatment was performed with excellent subsequent evolution. Conclusions: tuberculosis is a re-emerging disease in our country, which requires a high level of suspicion. Its diagnosis remains a challenge for pediatricians since diagnostic confirmation is not always possible. In this clinical case, clinical suspicion of chronic dysphonia associated with respiratory symptoms were key factors to establish the diagnosis, despite not having a clear epidemiological link.

Introdução: a tuberculose (TB) é uma doença infecciosa granulomatosa crônica causada pelo Mycobacterium tuberculosis. No Uruguai, houve aumento do número de casos notificados, com uma incidência notificada em 2017 de 28,6/100.000 habitantes, sendo 6,67/100.000 casos de menores de 15 anos. A tuberculose laríngea é uma forma rara e evoluída de tuberculose, que geralmente se manifesta com disfonia crônica, exigindo alto índice de suspeita. Objetivo: descrever um caso clínico de apresentação pouco frequente em idade pediátrica. Caso clínico: menina adolescente de 13 anos, saudável, totalmente vacinada, com história de comportamentos sexuais ativos e papilomatose laríngea diagnosticada por laringoscopia direta como causa de disfonia crônica. Consulta de urgência por dor abdominal, comprovando emagrecimento associado a sintomas respiratórios e síndrome bacilar tóxica associada a disfonia crônica de quatro meses de evolução, para a qual foi considerada tuberculose laríngea e a paciente foi internada para estudo. Ele nega contato com tuberculose. A radiografia de tórax revelou lesão cavernosa em ápice pulmonar esquerdo e as baciloscopias de escarro foram positivas (direta e cultura) confirmando a sugestão de TB pulmonar e laríngea. O tratamento antituberculose supervisionado foi realizado com excelente evolução subsequente. Conclusões: a tuberculose é uma doença reemergente em Uruguai e requer alto índice de suspeita. Seu diagnóstico permanece um desafio para o pediatra, pois a confirmação diagnóstica nem sempre é possível. Neste caso clínico, a suspeita clínica de disfonia crônica associada a sintomas respiratórios foi fundamental para o estabelecimento do diagnóstico, apesar de não ter vínculo epidemiológico.

Tuberculosis laríngea. Diagnóstico inicial mediante tomografía computarizada de detección múltiple / No disponible

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Factors Associated with Clinical and Topographical Features of Laryngeal Tuberculosis.

INTRODUCTION: Laryngeal tuberculosis (LTB) is the most frequent granulomatous disease of the larynx and represents less than 2% of extrapulmonary TB cases. There are no pathognomonic clinical and endoscopic features of this disease and studies on LTB that can assist in its diagnostic characterization are lacking. OBJECTIVE: To identify factors associated with clinical and topographical features of LTB. METHOD: a retrospective cross-sectional study was conducted from the medical records of 36 patients with confirmed LTB diagnosis. RESULTS: Dysphonia and cough were the main symptoms presented by patients and the true vocal folds the most frequently affected site. The average of the duration of the disease evolution was significantly higher in patients with dysphonia than in patients without this symptom. We observed association between dysphonia and true vocal fold lesions and between odynophagia and lesions in the epiglottis, arytenoids and aryepiglottic folds. Odynophagia was more frequent in individuals with lesions in four or more laryngeal sites. Weight loss equal or above 10% of the body weight was more frequent in patients with odynophagia as first symptom and in patients with ulcerated lesion. Dyspnea on exertion was more frequent in individuals with more extensive laryngeal lesions. The percentage of smokers with lesions in four or more laryngeal sites was greater than that found in non-smokers. Laryngeal tissue fragment bacilloscopy and culture examinations were less positive than sputum ones. CONCLUSIONS: Smoking appears to be associated with the development of more extensive LTB lesions, and LTB with dyspnea on exertion and odynophagia with consequent impairment of nutritional status. We emphasize the need for histopathologic confirmation, once positive sputum bacteriological examinations seem not to necessarily reflect laryngeal involvement.

Nasopharyngeal tuberculosis mimicking nasopharyngeal carcinoma on (18)F-FDG PET/CT in a young patient.

A 30-year-old woman presented with a painless left upper neck swelling for more than a week. Fibrolaryngoscope examination suggested nasopharyngeal carcinoma. FDG PET/CT was performed for an initial staging, which revealed intense activity in the soft tissue mass in the nasopharynx and cervical lymph nodes. However, biopsy from the nasopharyngeal lesion demonstrated tuberculosis.

[Laryngeal tuberculosis masquerading as carcinoma. Report of one case and literature review]. / Tuberculosis laríngea simulando carcinoma. Presentación de un caso y revisión de la literatura.

Since the introduction of antituberculous medications, the incidence of laryngeal tuberculosis (LTB) has decreased. However, it is a fact the increasing number of cases of pulmonary or extrapulmonary TB mainly caused by the Acquired Immunodeficiency Syndrome. We report the clinical case of a 72 years old male with dysphonia secondary to LTB which masqueraded a carcinoma. It's certain diagnosis was the histopathologic exam of the biopsy obtained by microsurgery. There was a residual TB in lung after a complete study of Internal Medicine Department.

Laryngeal tuberculosis masquerading as carcinoma.

With the advance of effective anti-tuberculosis drugs and the natural decline of tuberculosis (TB) in the developed world, the incidence of laryngeal TB has decreased and remains stable. However, compared to the situation in the past, the otolaryngologist may encounter uncommon clinical presentation of laryngeal TB nowadays. We describe one such case presenting with a laryngeal lesion with clinical and radiological features of a neoplastic rather than an infectious process.

Laryngeal tuberculosis: a report of 15 cases.

Laryngeal tuberculosis is usually a complication of pulmonary tuberculosis. Recent studies have described a change in the clinical features of laryngeal tuberculosis. We present 15 cases of laryngeal tuberculosis treated at the Osaka Prefectural Habikino Hospital between 1993 and 2000. The results showed a mean age of 51 years, a male predominance by 2.75 to 1, and a 20% incidence (n = 3) of negative chest radiographic findings. The prominent presenting symptom was hoarseness (73.3%), and systemic symptoms were relatively rare. Seven patients showed ulcerative lesions, 5 showed granulomatous lesions, and the remaining 3 showed nonspecific inflammatory lesions in the larynx. Laryngeal lesions did not show any predilection for specific laryngeal sites in our series. In contrast to earlier studies, our study shows variations in clinical features of laryngeal tuberculosis. Physicians should consider tuberculosis in the differential diagnosis of laryngeal disease.

[Laryngeal tuberculosis. A rare, but important differential diagnosis to chronic laryngitis]. / Tuberkulose i larynx. En sjaelden, men vigtig differentialdiagnose til kronisk laryngitis.

A middle-aged native Danish man became aphonic with chronic laryngitis. The symptoms persisted despite antibiotic treatment, and chest X-ray disclosed a central pulmonary infiltrate. Histopathology on specimens from the larynx and lung and microscopy and culture of the sputum revealed primary lung tuberculosis with spread to the larynx. At presentation, laryngeal tuberculosis often mimics non-specific chronic laryngitis or laryngeal carcinoma. It should be suspected when the clinical course is unusual. Tuberculosis may develop in the absence of risk factors.

The association of secondary tonsillar and laryngeal tuberculosis: a case report and literature review.

Tonsillar and laryngeal tuberculosis are rare diseases. We report a case with a tonsillar and laryngeal lesion. Histopathological and bacteriological examinations established the diagnosis of tonsillar and laryngeal tuberculosis associated with asymptomatic pulmonary focus.

Laryngeal tuberculosis: an important diagnosis.

The incidence of laryngeal tuberculosis is increasing worldwide. To ensure early diagnosis it is important for physicians and otolaryngologists to recognize its cardinal signs and symptoms. We present two recent cases of laryngeal tuberculosis that presented to our department. We outline potential pitfalls in diagnosis, and highlight the importance of obtaining a tissue diagnosis. The literature is reviewed, and the treatment options outlined.

Tuberculosis of the pyriform fossa--a rare entity.

Tuberculosis of the pharynx is less common than tuberculosis of the larynx. We present a rare case of tuberculosis of the pyriform fossa which clinically masqueraded as a malignancy. Our patient showed a prompt improvement in symptoms after commencing antitubercular treatment.

CT findings of laryngeal tuberculosis: comparison to laryngeal carcinoma.

PURPOSE: Our goal was to describe the appearance of laryngeal tuberculosis using CT, with the intent of identifying features distinguishing laryngeal tuberculosis and carcinoma. METHOD: CT scans of 12 patients with laryngeal tuberculosis were analyzed retrospectively. Clinical symptoms, laryngoscopic exams, and presence of pulmonary tuberculosis on chest radiographs were also reviewed. RESULTS: In laryngeal tuberculosis, bilateral involvement was noted in nine patients (75%), while unilateral involvement was seen in three (25%). Diffuse thickening of the free margin of the epiglottis was a characteristic and frequent finding in tuberculosis (n = 6, 50%). No deep submucosal infiltration of the preepiglottic and paralaryngeal fat spaces was seen even when there was extensive involvement of the laryngeal mucosa. Cartilage destruction was not found in any case. CONCLUSION: Characteristic CT findings of laryngeal tuberculosis include bilateral involvement, thickening of the free margin of the epiglottis, and good preservation of the preepiglottic and paralaryngeal fat spaces even in the presence of extensive mucosal involvement. By comparison, laryngeal carcinoma presented unilateral involvement, infiltration of the preepiglottic and paralaryngeal fat spaces by a submucosal mass, cartilage destruction, and extralaryngeal invasion.

[Laryngeal tuberculosis: a diagnosis not to be forgotten]. / La tuberculose laryngée: diagnostic à ne pas oublier.

Tuberculosis of the larynx has become a rarity since the discovery of streptomycin in 1944. In this article a personal case history is described, together with a review of the literature and an analysis of the main clinical features of tuberculosis of the larynx. The pseudo-tumoural form of tuberculosis is often indicative of the presence of pulmonary tuberculosis, but may also occur in isolation. Histology is often the only definitive diagnostic test.

Subglottic stenosis secondary to tuberculosis.

Although the incidence of laryngeal tuberculosis has been declining over the past 30 years, it should still be considered in the differential diagnosis of patients with laryngeal pathology. In contrast to the pre-chemotherapy era, few, if any, signs of pulmonary tuberculosis are seen in such cases, and presentation is similar to either chronic non-specific laryngitis or carcinoma. The subglottis is a site rarely involved in laryngeal tuberculosis. Tissue biopsy and culture are diagnostic and a full course of antituberculous chemotherapy usually resolves the condition. Airway insufficiency due to fibrosis, however, often necessitates surgical intervention. We present a case where the only laryngeal manifestation of tuberculosis was subglottic stenosis.

Laryngeal tuberculosis: CT findings.

OBJECTIVE: The purpose of this study was to evaluate the CT findings of laryngeal tuberculosis (TB). SUBJECTS AND METHODS: CT scans, laryngoscopic examinations, and chest radiographs of 12 patients (21-63 years old) with histologically (n = 8) or bacteriologically (n = 4) confirmed laryngeal TB were retrospectively reviewed. RESULTS: Bilateral diffuse thickening of the vocal cords and diffuse thickening and increased density of the aryepiglottic folds and paralaryngeal tissues were present in all patients. Diffuse thickening of the epiglottis was observed in seven patients. In four patients, a focal mass was noted in the anterior portions of the vocal cords (n = 3) or tip of the epiglottis (n =1). Destruction or sclerosis of cartilage was not found. Subglottic extension of the lesion was suspected in only one patient. Enlarged cervical lymph nodes were found in five patients. On laryngoscopic examinations, swelling of the vocal cords (n = 12) or epiglottis (n = 6) was present in all patients and was bilateral in nine patients. Vocal cord mobility was impaired in only one patient. Radiographic findings consistent with active pulmonary TB were present in all patients. CONCLUSION: Although the CT appearances of laryngeal TB are not specific, the possibility of laryngeal TB should be raised when bilateral and diffuse laryngeal lesions are encountered without destruction of the laryngeal architecture in patients with pulmonary TB.