CO-EXISTENCE OF PULMONARY, TONSILLAR AND LARYNGEAL TUBERCULOSIS

Abstract

A 56-year old male applied to otorhinolaryngology clinic with sore throat and dysphagia. During direct examination, left palatine tonsil and tonsil plicas ulcerovegetative lesions were found. In the indirect laryngoscopy, in some regions of the larynx and epiglottis, ulcerovegetative lesions were observed too. Because of suspicion of laryngeal carcinoma and metastasis, punch biopsy of the left palatine tonsil was performed. Chest x-ray and computerized tomography of the thorax revealed two adjacent cavitations in the apicoposterior segment of the left upper lobe. In the histopathologic examination of biopsies, granulomatous structures that proved tuberculosis were observed. In the fiberoptic bronchoscopic analysis, endobronchial lesion was not detected. Acid-fast bacilli were determined in sputum and bronchial lavage in microscopy and culture. The case of this middle aged male patient; with co-existence of tonsillar, laryngeal and pulmonary tuberculosis presents the clinical significance of upper airway tuberculosis in terms of its infectiousness and rare occurrence.

Keywords

• Pulmonary tuberculosis
• tonsillar tuberculosis
• laryngeal tuberculosis

References

1. Öztop A, Ünsal İ, Günay T, Oğuz AV, Çakmak R. An analysis of adult patients with pulmonary and extrapulmonary tuberculosis. Turk J Med Sci 2009; 39: 725-732.
2. Uysal G, Gursoy T, Altunc U, Guven A. Asymptomatic pons tuberculoma in an infant with miliary tuberculosis. Saudi Med J 2005; 26: 1277- 1279.
3. Pino Rivero V, Marcos Garcia M, Gonzalez Palomino A, et al. Laryngeal tuberculosis masquerading as carcinoma. Report of one case and literature review. An Otorrinolaringol Ibero Am 2005; 32: 47-53.
4. Smallman LA, Clark DR, Raine CH, Proops DW, Shenoi PM. The presentation of laryngeal tuberculosis. Clin Otolaryngol Allied Sci 1987; 12: 221-225.
5. de Bree R, Chung RP, van Aken J, van den Brekel MW. Tuberculosis of the larynx. Ned Tijdschr Geneeskd 1998; 142: 1676-1680.
6. Yamamoto K, Iwata F, Nakamura A, et al. Tonsillar tuberculosis associated with pulmonary and laryngeal foci. Intern Med 2002; 41: 664-666.
7. Egeli E, Oghan F, Alper M, Harputluoglu U, Bulut I. Epiglottic tuberculosis in a patient treated with steroids for Addison's disease. Tohoku J Exp Med 2003; 201: 119-125.
8. Sezer B, Zeytinoglu M, Tuncay U, Unal T. Oral mucosal ulceration: a manifestation of previously undiagnosed pulmonary tuberculosis. J Am Dent Assoc 2004; 135: 336-340.

9. Yigit O, Cinar U, Uslu CB, Basak T. Tuberculous ulcer of the tongue: a case report. The Turkish Journal of Ear Nose and Throat 2004; 13: 98-101.
10. Alatas F, Metintas M, Erginel S, et al. Co-Existence of Lung and Larynx Tuberculosis. Tuberculosis and Thorax 1998; 45: 290-294.
11. Davis YM, McCray E, Simone PM. Hospital infection control practices for tuberculosis. Clin Chest Med 1997; 18: 19-33.
12. Porras Alonso E, Martin Mateos A, Perez-Requena J, Avalos Serrano E. Laryngeal tuberculosis. Rev Laryngol Otol Rhinol 2002; 123: 47-48.
13. Tucker HM. Infectious and inflammatory disorders. In: Tucker HM, editor. The Larynx. 2nd ed. New York: Thieme, Medical Publishers; 1993, 231-244.
14. Broek PV. Acute and chronic laryngitis; leucoplakia. In: Stell PM, editor. Laryngology. London: Butterworth Ltd, 1987: 99-118.