Atypical mycobacteriosis of the larynx: an unusual clinical presentation secondary to steroids inhalation.
Vocal cords stiffness can be associated with a variety of etiologic agents, but it is rarely seen with atypical mycobacteria, for example, Mycobacterium avium complex. We report a case of a 35-year-old white woman who is and was maintained on inhaled steroids. She presented with hoarseness and low-grade fever, but her medical history was otherwise unremarkable. Laryngoscopy revealed bilateral scarring of the vocal cords. Vocal cord biopsies were performed. Histologic examination revealed unremarkable laryngeal mucosa, except for abundant subepithelial non-necrotizing granulomata. The differential diagnosis included sarcoid, Klebsiella scleroma, and tuberculosis. Special stains reviewed abundant acid-fast bacilli, later confirmed by a DNA assay on induced deep sputum, consistent with M avium complex. Subsequently, steroids were withdrawn, and the patient was treated with a multiple-drug antituberculous regimen and had a full recovery. This unusual clinical presentation of the atypical mycobacteriosis may be encountered by otolaryngologists and pathologists, and it is critical to recognize it in patients immunocompromised because of steroids.
Wang
Beverly Y
BY
Department of Pathology, Tisch Hospital, H461, New York University Medical Center, NY 10016, USA. Beverly.wang@nyumc.org
Amolat
May Jennifer
MJ
Woo
Peak
P
Brandwein-Gensler
Margaret
M
D000280:Administration, Inhalation; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D001706:Biopsy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007818:Laryngeal Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D007830:Larynx / Q000382:microbiology / Q000473:pathology; D015269:Mycobacterium avium Complex; D015270:Mycobacterium avium-intracellulare Infection / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D013256:Steroids / Q000008:administration & dosage / Q000009:adverse effects*; D014827:Vocal Cords / Q000382:microbiology / Q000473:pathology
D000995:Antitubercular Agents; D013256:Steroids