A 72 years old man presented to the Outpatient Clinic of Otolarygology of Rouhani Teaching Hospital with complaints of hoarseness, low grade fever with decreased appetite for a duration of one month. He had no cough or expectoration. The patient was not a smoker and with no alcohol and drug abuse. His wife had pulmonary tuberculosis 14 years ago and was treated with anti tuberculosis agents. She died five years ago due to myocardial infarction. His 14 year old daughter had subcutaneous tuberculosis of the femur 16 years ago without involvement of her lung or spine.
In general physical examination, he was conscious. There was no cervical lymphadenopathy or clubbing. There were no scars or sinuses in the neck. Indirect laryngoscopy had shown a growth in the right ary-epiglottic fold (figure 1). Vocal cords were moving with no signs of infiltration. The respiratory system examination and chest x-ray were normal. PPD test showed 15 mm indurations after 48 hours. After a standard evaluation, the patient underwent laryngoscopy under local anesthesia and biopsy was taken from epiglottis.
The histopathological examination revealed biopsy tissue lined by stratified squamous epithelium showing focal dysplasia. Underlying stroma showed diffuse infiltration by lymphocytes, plasma cells, occasional polymorphs along with epitheloid granulomas, langhans giant cells and caseous necrosis (figure 2). Histopathologic findings confirmed tuberculosis as the cause of his hoarsness and he was treated with standard regimens of therapy.
A standard six month treatment with a combination of isoniazid, rifampicin, pyrazinamide, and ethambutol was started for two months followed by isoniazid and rifampicin for additional four months. The follow up after treatment showed resolution of the symptoms and improvement of the mass (figure 3).