An Atypical Presentation of Extrapulmonary Tuberculosis with Acute Airway Obstruction Masquerading Laryngeal Carcinoma: A Case Report

Primary laryngeal tuberculosis (LTB) is rare. The misdiagnosis rate is high due to its vague symptoms. This report aimed to highlight the clinical and radiological aspects of a primary LTB case, where patient presented with laryngeal mass and acute upper airway obstructive symptoms. The challenges of diagnosis and insights learnt were shared which may facilitate prompt case management in the future. A 70-year-old man presented with acute stridor and dyspnoea. Multiple subglottic mass with significant airway obstruction was discovered during laryngoscope examination. The radiological evidence of retro-tracheal mass appeared in continuity with thoracic oesophagus, the lack of clinical pulmonary symptom in addition to the negative general tuberculosis (TB) workup including biopsy for Acid-Fast Bacilli, had collectively led the initial working diagnosis towards malignancy. The challenges of difficulty in obtaining subglottic mass biopsy with multiple attempts were also discussed. The diagnosis of primary LTB was established after a positive polymerase chain reaction (PCR) result obtained for Mycobacterium Tuberculosis at forth biopsy attempt. LTB may be manifested in a variety of laryngeal symptoms. This study underscored the complexity inherent in diagnosing primary LTB, in which the presentation of acute upper airway obstruction deserved a comprehensive diagnostic approach, collaboration of diverse medical specialists, adherence to established treatment guidelines, and the crucial role of continuous patient monitoring. This report emphasised the necessity for a high degree of suspicion for LTB in patients presented with upper respiratory tract lesions especially within the endemic regions with high TB prevalence, to achieve early diagnosis and treatment.