Laryngeal Tuberculosis in HIV‐Infected Patients: A Difficult Diagnosis

Abstract

Unrecognized laryngeal tuberculosis (TB) poses a significant hazard to otolaryngologists. However, the changing manifestations of TB in patients with human immunodeficiency virus (HIV) infection can make its diagnosis difficult. In our population of 146 patients with TB involving the head and neck, HIV infection was present in 70 cases (48%). The prevalence of laryngeal TB in this population was 5.5% (8 patients). Concomitant HIV infection was present in 2 (25%) of 8 patients with laryngeal TB. A delay in the diagnosis of laryngeal TB occurred in 100% of patients with HIV infection, compared with 17% of non-HIV-infected patients (P = .055). The cause of the delayed diagnosis was multifactorial, mainly the presence of multiple confounding variables and the carcinoma-like appearance of the laryngeal TB lesions in HIV-infected patients. To reduce risk for transmission of TB to health care providers, a high level of suspicion must be present for all patients with laryngeal lesions, especially those with HIV infection.

Tuberculosis of the Larynx: A Review of Two Cases

“…13,14 In the present two cases, both the lesions were restricted to unilateral vocal cord superior surface without involving any other area of the larynx. However, in both the cases, the supraglottic laryngeal mucosa showed marked congestion, which is similar to that observed by Singh et al 9 In a study of tubercular laryngitis in 14 patients, Ozüdogru et al 12 had observed that glottal closure presented an irregular shape during treatment, and later became spindle shaped along its entire length. They had also noted the absence of mucosal wave in the posttreatment period, which is contrary to our finding of a normal mucosal wave and normal glottal closure after completion of treatment.…”

“…In the presence of acquired immunodeficiency syndrome, the clinical presentation becomes confusing. 9 Also, in the Indian scenario, very often, with an associated history of oral habits like tobacco intake, smoking, etc., laryngeal tuberculosis mimics a malignant lesion of the larynx.…”

Tuberculosis in otolaryngological practice

“…8 HIV infected patients generally have increased risk of otorhinolaryngeal tuberculosis. 10 But in our study, only 3 out of 27 patients were found to be HIV positive.…”

Primary Tuberculosis Involving Epiglottis: A Rare Case Report

“…Indeed, the resurgence of tuberculosis is attributed to the increased prevalence of immunodeficiency states. Singh et al [11] reported that in his study HIV infection had accompanied 25% of the cases of laryngeal TB. Every patient with TB should be screened for HIV.…”