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A Rare Case of Laryngeal Tuberculosis in Children

Wulandari DP, Triasih R and Nugraha RP

Background: Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. It has a high prevalence in the world with a fairly high mortality rate. The most common affected organ is the lungs, but in recent years an increase of extrapulmonary TB incidence, one of which tuberculosis of the larynx. The larynx is the 3rd most common area affected by TB from the area of the ear-nose-throat after cervical lymph nodes and ears. Laryngeal tuberculosis potentially cause fatality due to severe odynophagia and dyspnea due to laryngeal edema and granulation. The prevalence of laryngeal tuberculosis is extremely rare in children. Worldwide, the population of children affected by tuberculosis is quite high, mostly in developing countries. Extrapulmonary involvement in children is common, but larynx is a rare site of infection.

Case report: Reported a case of laryngeal TB in 7 months child. Patient had a history of positive TB contacts. She had dysphonia and a history of shortness of breath. Inspiratory stridor, substernal and intercostal retractions, and thick discharge was found on examination. Endoscopic examination revealed type 1 laryngomalacia (redundancy of arytenoid tissue), diffuse laryngeal edema, granulation around laryngeal inlet and arytenoid, and irregularities in vocal cords mucosa with normal vocal cord movement. Sputum smear examination and GeneXpert TB test obtained with positive result and there was no rifampicin resistance. Patient treated with paediatric antituberculosis therapy. Evaluation after 2 weeks of therapy has shown significant clinical improvements, reduced laryngeal edema and decreased granulation tissue.

Conclusion: A rare case of laryngeal TB in children has been reported. The diagnose was made with endoscopic examination and GeneXpert TB test. The child has been treated with children OAT regimen and showed improvement in clinical condition.