Chronic laryngitis caused by Mycobacterium Kansasii in a traveler

Abstract

Chronic laryngitis commonly presents with dysphonia, and infectious causes include tuberculosis and endemic mycoses. We present a 58-year-old female with laryngitis for 5 years, fevers, chills, fatigue, malaise, myalgias, anterior neck pain, and night sweats after multicontinent exposure. Bronchoscopy cultures were negative. Bilateral microflap excision of vocal fold lesions demonstrated thickened epithelium and a deep vocal fold mass. Biopsy showed necrotizing granulomatous inflammation with acid-fast bacilli. Mycobacterium kansasii was identified. Treatment led to improvement in dysphonia, systemic symptoms, and vocal fold irritation. To our knowledge, this is the first case of isolated nontuberculous mycobacterial vocal fold infection.

Nontuberculous Mycobacterial Infection of Larynx and Cervical Trachea

“…5,8 Laryngeal NTM involvement is rare with only 7 prior studies reporting cases. [2][3][4][5][6][7][8] The limited mention of any tracheal involvement in NTM disease comes from one study describing tracheobronchial lesions found on bronchoscopy. 10 Our case demonstrates possible complications, such as subglottic stenosis, from treatment of NTM infection.…”

“…Following successful diagnosis and treatment of laryngeal NTM, most of the literature describes complete resolution of disease without complications. [2][3][4][6][7][8] This was not the case for our patient with laryngeal and cervical tracheal NTM disease. Although she initially improved, she developed subglottic stenosis that required dilation.…”

“…Obtaining additional information than tissue histopathology results, either with in the form of tissue culture and/or PCR analysis, is crucial in the prompt diagnosis of laryngeal NTM. 2,4,5 The treatment of NTM infection includes prolonged, multiagent therapy. Obtaining 12 months of negative AFB cultures and imaging stability are the goals of therapy.…”

“…1 While NTM infection most commonly involves the pulmonary system, prior studies have documented head and neck involvement. [2][3][4][5][6][7][8] Laryngeal NTM infections are exceedingly rare. Failure to consider an atypical mycobacterial infection in the differential diagnosis when presented with an ulcerative, exophytic mass may result in insufficient tissue evaluation, delayed diagnosis, and disease progression.…”

Atypical Laryngeal Infections: Localized Lesions from Unusual Organisms May Simulate Malignancy

“…We found only seven documented cases of laryngeal NTM in the literature [11][12][13][14][15] including the slow-growing Mycobacterium avium, kansasii and malmoense. Presentations included vocal fold mucosal thickening, 11,12,15 multifocal ulcerations 14 and pseudotumor development. 13 To our knowledge, the present case is the first described laryngeal infection by a fast-growing NTM, Mycobacterium fortuitum.…”