Leukoplakia or LPR: The Misdiagnosis of Laryngeal Tuberculosis

Abstract

Objective:The objective is to reduce the rates of misdiagnosis and inappropriate treatment of laryngeal tuberculosis (LTB).Study Design:Retrospective case series.Materials and Methods:Medical records of 3 histopathology-confirmed cases at a tertiary medical center from 2000 to 2018.Results:Seventeen patients with LTB included in this study. Of the 17 patients, 16 patients were male and 1 was female; 11 patients had a history of smoking. Odynophagia was the chief complaint in 6 cases, and 11 patients complained of hoarseness. The appearance of the affected larynx was ranged from diffuse swelling (n = 7, 41.2%), mucosa white lesion (n = 5,29.4%), and granulomatous tumors (n = 2, 11.76%), and these features presented together (n = 2, 11.76%). Seventeen patients with LTB were misdiagnosed as acute epiglottitis in 4 (23.5%) patients, acute laryngitis in 1 (5.9%) patient, leukoplakia in 5 (29.4%) patients, laryngopharyngeal reflux (LPR) in 6 (35.3%) patients, and laryngocarcinoma in 1 (5.9%) patient. Chest computed tomography reported old pulmonary tuberculosis in 2 (11.7%) patients, active pulmonary tuberculosis in 7 (41.2%) patients, and normal lung status in 8 (47.1%) patients. Histopathological examination reported Mycobacterium tuberculosis infection by revealing epithelioid cell granulomas with Langhans-type giant cells in 14 (82.4%) patients and epithelioid cell granulomas with caseous necrosis and Langhans-type giant cells in 3 (17.6%) patients.Conclusions:Laryngeal tuberculosis was easily misdiagnosed as acute epiglottitis or leukoplakia because of diffuse swelling of the epiglottis or white lesions over the true vocal cord, especially patients with increasing LTB were misdiagnosed as LPR with the enhancement of LPR awareness among otolaryngologist. Clinicians should be aware of the possibility of LTB for chronic intractable laryngitis with failure treatment of proton pump inhibitor and recurrent acute epiglottitis with foreign body injury.

Tuberculosis laríngea

“…Por lo tanto, se requiere de alta sospecha clínica para hacer el diagnóstico. Según algunos reportes previos, los signos y síntomas más usuales son la disfonía y la odinofagia [2][3][4]. Se sugiere considerar la posibilidad del diagnóstico de tuberculosis cuando se presente algún tipo de inmunocompromiso, disfonía crónica, odinofagia y pérdida de peso asociado.…”

Comparing suspension laryngoscopic mucosal dissection and plasma resection for laryngeal leukoplakia: prognostic outcomes

“…Patients in the study group underwent cryoplasma resection. (1) The laryngoscope was delivered to the larynx through the mouth, pharynx, and epiglottis to fully expose the laryngeal cavity operation area, and the laryngoscope was fixed after determining the location and extent of the lesion; (2) The low-temperature plasma knife head was bent into an arc, with the cutting parameters adjusted to 7 gears and the coagulation parameters adjusted to 4 gears for resection of the diseased mucosa; (3) For potentially fixed bleeding-prone areas, the plasma knife was maintained in the same position after resection and ablation, and replaced with a hemostasis gear for hemostasis, i.e., resection and hemostasis were performed in the same surgical site. All patients were given intravenous fluids promptly after surgery.…”

“…Laryngeal leukoplakia is a condition characterized by the hyperplasia and hyperkeratosis of the laryngeal mucosa epithelium, leading to the formation of white patches or patchy bulges on the surface of the laryngeal mucosa, with occa-sional reddish lesions [1]. The disease is associated with various risk factors, including laryngeal reflux disease, chronic tobacco and alcohol use, improper voice usage, exposure to carcinogens, and compromised immunity [2,3].…”