Bizarre Laryngo-Pharyngeal Manifestation in Disseminated Tuberculosis

Case Report

Austin J Clin Case Rep. 2014;1(6): 1026.

Bizarre Laryngo-Pharyngeal Manifestation in Disseminated Tuberculosis

Manish Gupta1*, Monica Gupta2, Dinesh Kumar1, Shivani Jindal3

1Department of ENT, Gian Sagar Medical College & Hospital, India

2Department of Medicine, Gian Sagar Medical College & Hospital, India

3Department of Pathology, Gian Sagar Medical College & Hospital, India

*Corresponding author: Manish Gupta, Department of ENT, Gian Sagar Medical College & Hospital, 1156-C, Govt. Medical College & Hospital Campus, Sector 32-B, Chandigarh 160030, India

Received: June 24, 2014; Accepted: July 04, 2014; Published: July 07, 2014


Tuberculosis is known by the adage “the great mimic” because of its multisystem polymorphic manifestations. In countries with high tuberculosis burden, the medical practitioner may encounter such bizarre presentations that it is almost like rediscovering tuberculosis. We present a case of young lady presenting with absolute dysphagia, multiple ulceroproliferative lesions involving both oropharynx and larynx in addition to concurrent miliary tuberculosis. The biopsy from oropharyngeal lesions clinched the diagnosis and the patient responded to antitubercular chemotherapy. The simultaneous occurrence of ulceroproliferative oropharyngeal lesions and miliary tuberculosis in an immunocompetent patient is intriguing and extremely rare.

Keywords: Laryngeal tuberculosis; Pharyngeal tuberculosis; Uvular destruction; Military dissemination


Tuberculosis (TB) still remains a deadly scourge in the Indian subcontinent. It is an infectious granulomatous disease caused by Mycobacterium tuberculosis, an acid-fast bacillus that is transmitted primarily via the respiratory route. It may present as primary or post-primary TB. Usually the primary focus is lungs and then the disease spreads secondarily to other organs through self inoculation via infected sputum, blood and lymphatic system.

Extrapulmonary tuberculosis (EPTB) can occur as an isolated entity or along with a pulmonary focus as in disseminated tuberculosis. Oropharyngeal TB lesions are infrequent and seen only in 0.05-5% of total TB cases [1]. It is thought to be secondary to direct inoculation of bacteria presented in the coughed out sputum, and is usually observed in patients with sputum positive cavitatory pulmonary TB. Our case was unique that oropharyngeal TB was observed without pulmonary cavitatory disease, but concurrently with disseminated (miliary) TB.

Case Presentation

A 23-year-old female visited our outpatient department with complaints of painful ulcerations and difficulty in swallowing since the past 6 months. The dysphagia was initially to solids and had progressed to liquids and even saliva. This was associated with cough and mild expectoration. She did not divulge any history of fever, loss of appetite or weight loss, chest pain or blood in sputum. There was no history to suggest change in voice or difficulty in breathing. There was no history of nasal blockage, discharge or earache. There was no significant illness in the past and family history was not contributory.

On oropharyngeal examination, multiple exophytic red granular tissues over uvula and posterior pharyngeal wall were noticed, with slough covered ulcers over soft palate in addition to thickened tonsillar pillars (Figure 1). The lesions were tender and bled on touch. The examination of larynx by angled rigid endoscope revealed similar lesions involving whole of posterior pharyngeal wall, right arytenoids and aryepiglottic fold, while the cords and epiglottis were spared (Figure 2). On neck examination, bilateral firm, mobile upper deep cervical lymph nodes sized 2x1.5 cm2 and left middle deep cervical 1x1cm2 were palpable. Patient was malnourished and weighed 40 kg at the time of admission.