Rare Case: Laryngeal TB Presents as Vocal Cord Lesion With Persistent Hoarseness in Healthy Young Woman
Ethiopia: A rare case of isolated laryngeal tuberculosis (TB) in an otherwise healthy young woman has been reported in BMC Infectious Diseases, drawing attention to an often-overlooked diagnosis in patients presenting with persistent hoarseness.
The case report, authored by Mohammedsefa Arusi Dari and colleagues from the Otolaryngology–Head and Neck Surgery Department at Addis Ababa University, highlights how laryngeal TB can masquerade as malignancy or chronic laryngitis, even in individuals with no immunosuppression or pulmonary involvement.
Laryngeal TB was once a frequent complication of advanced pulmonary tuberculosis, but its incidence has dropped significantly with the widespread availability of antibiotics. Despite this decline, it remains a relevant clinical concern in regions where TB continues to be endemic. Its presentation is often nonspecific, making a timely diagnosis difficult. The authors emphasize that clinicians should consider TB in patients with unexplained hoarseness, as delayed diagnosis can prolong morbidity and lead to unnecessary interventions.
The reported case involves a 33-year-old Ethiopian woman who had been experiencing hoarseness for six months, accompanied only by decreased appetite. She had no history of cough, fever, night sweats, or respiratory symptoms. The patient was immunocompetent, a non-smoker, and had no family history of tuberculosis or chronic disease. Physical examination showed no neck swelling or lymphadenopathy.
Indirect laryngoscopy revealed an ulcerated lesion confined to the right vocal cord, while the rest of the laryngeal structures appeared normal. Routine investigations—including sputum AFB testing and chest X-ray—did not indicate pulmonary TB. However, the strongly positive tuberculin skin test raised suspicion of extrapulmonary tuberculosis.
A vocal cord biopsy was subsequently performed. Histopathological analysis demonstrated caseating granulomas with Langhans giant cells, a classic finding in tuberculosis. Acid-fast staining confirmed the presence of rod-shaped bacilli, and GeneXpert testing further validated the diagnosis, ruling out resistance to first-line TB medications isoniazid and rifampicin.
The patient was started on standard anti-tubercular therapy, consisting of a two-month intensive phase with isoniazid, rifampicin, pyrazinamide, and ethambutol, followed by four months of continuation therapy with isoniazid and rifampicin. Given the localized nature of the disease and the patient’s favorable progress, treatment was extended for an additional three months to ensure complete resolution.
Follow-up evaluations at three and six months demonstrated striking improvement. Her hoarseness resolved completely, and repeat laryngoscopy showed a fully healed vocal cord without any scarring or residual abnormalities. She tolerated the treatment regimen well and achieved full recovery.
The authors note that cases like this highlight the importance of including laryngeal TB in the differential diagnosis of persistent hoarseness, even in patients with no traditional risk factors. Early biopsy and prompt initiation of therapy are key to preventing complications such as vocal cord scarring or airway obstruction. The successful outcome in this patient reinforces the value of maintaining clinical vigilance for extrapulmonary TB, particularly when encountering atypical laryngeal lesions in TB-endemic settings.
Reference:
Dari, M.A., Hassen, Z.S. & Muluneh, M.A. Laryngeal tuberculosis presenting as an isolated vocal cord lesion in an immunocompetent patient: a case report. BMC Infect Dis 25, 1650 (2025). https://doi.org/10.1186/s12879-025-12084-x
Next Story