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• W4387265787 abstract "SESSION TITLE: Chest Infections Global Case Report Posters 1 SESSION TYPE: Global Case Reports PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm INTRODUCTION: Laryngeal Tuberculosis (TB) is a rare form of TB. Patients may present with hoarseness of voice or dyspnea. However, as symptoms may develop gradually, it can be misdiagnosed for other conditions. We present a case with Rifampicin resistant (RR)-TB laryngitis who was initially treated for asthma. CASE PRESENTATION: A 41 year-old Filipino lady presented to the Emergency Department (ED) with 3 days of dyspnea. She was diagnosed to have asthma 3 years ago, presenting with recurrent cough, wheeze and shortness of breath. Her asthma was managed with inhaled corticosteroids. In the ED, she was dyspneic and found to have noisy breathing with widespread wheeze. The initial chest radiograph was reported as normal. She was treated for status asthmaticus, and eventually required endotracheal intubation due to type 2 respiratory failure on the arterial blood gas. Laryngoscopy during intubation showed swelling of the upper respiratory tract. Her wheeze resolved immediately post-intubation, with normal airway mechanics on mechanical ventilation. A course of intravenous steroids was started and liberation from the ventilator was successful on day 4 after a positive cuff leak test. Repeat laryngoscopy showed swelling of the vocal cords. Additional history of worsening hoarseness of voice in the preceding year was obtained. CT scan of the neck revealed diffuse swelling of the vocal cords, false cords and arytenoids with centrilobular nodules in the upper lobes of the lungs. Autoimmune screen, bacterial screen and sputum acid-fast bacilli (AFB) smear was negative. However, sputum TB-GeneXpert was positive with rifampicin resistance detected. AFB culture grew Mycobacterium tuberculosis, resistant to rifampicin but sensitive to isoniazid, ethambutol and pyrazinamide. She was started on RR-TB treatment however she had persistent airway symptoms. A tailing dose of prednisolone was added on one month into therapy, with improvement in her symptoms and repeat laryngoscopy showed improvement in vocal cord swelling. She was discharged and continued on TB treatment via directly-observed therapy. DISCUSSION: Laryngeal TB accounts for less than 1% of all TB cases. It can develop due to direct spread of Mycobacterium to the larynx from sputum or hematogenous spread. Patients typically respond well to anti-TB treatment. While steroids are used in the management of many laryngeal diseases, such as epiglottitis and laryngeal edema, data for the use of steroids in laryngeal TB is lacking. It's benefit may be extrapolated from the evidence behind the use steroids for inflammatory laryngeal conditions and its use as an adjunctive therapy in the treatment of certain sites of TB. CONCLUSIONS: Laryngeal TB is an uncommon clinical entity that should be considered in patients from endemic regions. The adjunctive use of steroids together with appropriate anti-TB medication may improve outcomes. REFERENCE #1: Williams, R., & Douglas-Jones, T. Mycobacterium marches back. The Journal of Laryngology & Otology, 109(1), 5-13. REFERENCE #2: Campagnolo, et al. Steroid injection in chronic inflammatory vocal fold disorders, literature review. Braz J Otorhinolaryngol 2008;74(6):926–32. REFERENCE #3: Critchley JA, Young F, Orton L, et al. Corticosteroids for prevention of mortality in people with tuberculosis: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13:223–37 DISCLOSURES: No relevant relationships by caroline choong No relevant relationships by Edmund Lim No relevant relationships by Timothy Toh" @default.
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• W4387265787 date "2023-10-01" @default.
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• W4387265787 title "NOT ALL THAT WHEEZES IS ASTHMA: LARYNGEAL TUBERCULOSIS AND THE ROLE OF STEROIDS" @default.
• W4387265787 doi "https://doi.org/10.1016/j.chest.2023.07.778" @default.
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