Clinical And Biological Factors Associated With Pulmonary Function Change During Anti-Tuberculous Treatment

Chen, Jung Yueh; Wang, Jann‐Yuan; Yu, Chong-Jen; Lee, Lina

doi:10.1164/ajrccm-conference.2010.181.1_meetingabstracts.a3147

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“…[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.…”

Section: Discussionmentioning

confidence: 76%

Nontuberculous Mycobacterial Infection of Larynx and Cervical Trachea

Lau¹,

Lackey²,

Samedi

et al. 2023

Ann Otol Rhinol Laryngol

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Objectives: To present a patient with the first case of NTM (nontuberculous mycobacteria) infection of the larynx extending to cervical trachea, and the first case of subglottic stenosis associated with an NTM infection. Methods: Case report and review of the literature. Results: A 68-year-old female with history of prior smoking, gastroesophageal reflux disease, asthma, bronchiectasis, and tracheobronchomalacia presented with a 3-month history of shortness of breath, exertional inspiratory stridor, and hoarseness. Flexible laryngoscopy demonstrated ulceration of medial aspect of right vocal fold and subglottic tissue abnormality with crusting and ulceration extending through the upper trachea. Microdirect laryngoscopy with tissue biopsies and carbon dioxide (CO2) laser ablation of disease completed, and intraoperative culture revealed positive Aspergillus and acid-fast bacilli with Mycobacterium abscessus (type of NTM). Patient began antimicrobial treatment of cefoxitin, imipenem, amikacin, azithromycin, clofazimine, and itraconazole. Fourteen months after initial presentation, patient developed subglottic stenosis with limited extension into the proximal trachea prompting CO2 laser incision, balloon dilation, and steroid injection of the subglottic stenosis. Patient remains disease free without further subglottic stenosis. Conclusion: Laryngeal NTM infections are exceedingly rare. Failure to consider NTM infection in the differential diagnosis when presented with an ulcerative, exophytic mass in patients with increased risk factors (structural lung disease, Pseudomonas colonization, chronic steroid use, prior NTM positivity) may result in insufficient tissue evaluation, delayed diagnosis, and disease progression.

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