Hurtado Alegre Jorge Luis, Trigoso Gutierrez Anita, Matos Prado Eduardo, Huaringa Marcelo Jorge
Infectious Diseases, Hospital Nacional Arzobispo Loayza, Universidad Nacional Mayor De San Marcos, Lima, PER.
Internal Medicine, Hospital Nacional Arzobispo Loayza, Universidad Nacional Mayor De San Marcos, Lima, PER.
Cureus. 2018 Nov 5;10(11):e3545. doi: 10.7759/cureus.3545.
Tuberculosis is the most frequent granulomatous disease but the involvement of the larynx is rare. Immunosuppressed patients have a higher risk of developing this clinical form due to primoinfection or reactivation of latent tuberculosis. It is common to confuse the diagnosis of laryngeal tuberculosis with laryngeal cancer because they have similar macroscopic lesions and both produce dysphonia of chronic evolution. We present the case of a pregnant woman with chronic dysphonia, dysphagia, and odynophagia, diagnosed initially with laryngeal cancer after the first laryngoscopy. However, the patient also presented with fever, productive cough, weight loss, and dyspnea. The sputum sample showed a positive result for acid-fast bacilli (AFB) test; chest X-ray was showed bibasal nodular lesions with a predominance of right hemithorax and reticular opacities in left apex. A new laryngoscopy revealed a mamelonated tumor in the arytenoid cartilage, which led to the initiation of the antituberculous treatment without confirming the diagnosis by biopsy, with clinical improvement and no serious sequelae at the end of treatment. The reason for presenting this case is to consider the possibility of tuberculosis in areas of high endemicity, in patients who have a laryngeal tumor of probable neoplastic etiology, and that a biopsy is not necessary for the diagnosis of laryngeal tuberculosis in cases associated with pulmonary symptomatology.
肺结核是最常见的肉芽肿性疾病,但喉受累情况罕见。免疫抑制患者因原发性感染或潜伏性结核复发而发生这种临床类型的风险更高。喉结核的诊断常与喉癌相混淆,因为它们有相似的宏观病变,且均会导致慢性进展性声音嘶哑。我们报告一例患有慢性声音嘶哑、吞咽困难和吞咽痛的孕妇病例,首次喉镜检查后最初被诊断为喉癌。然而,该患者还伴有发热、咳痰、体重减轻和呼吸困难。痰标本抗酸杆菌(AFB)检测呈阳性;胸部X线显示双肺底部结节性病变,以右半胸为主,左肺尖有网状阴影。再次喉镜检查发现杓状软骨有乳头状瘤,于是在未通过活检确诊的情况下开始抗结核治疗,治疗结束时临床症状改善且无严重后遗症。呈现该病例的原因是,在结核病高流行地区,对于患有可能为肿瘤病因的喉肿瘤患者,要考虑到患结核病的可能性,并且在伴有肺部症状的病例中,诊断喉结核不一定需要活检。