We report the case of a 56-year-old mestizo male, an otorhinolaryngologist, who consulted for progressive dysphonia of six months of evolution that increased during the day.
In another institution the nasolaryngoscopic diagnosis of hemorrhage in the left vocal cord and thickening of the ipsilateral vocal fold of possible etiology had been made.
The patient had a history of type II diabetes mellitus with proper management, allergic rhinitis and gastroesophageal reflux disease; reported smoking and drinking alcohol only occasionally.
On admission, the patient had good general condition, hydrated and afflicted surface; his blood pressure was 140 m Hg and his heart rate was 7226 beats per minute, his respiratory rate was 18 breaths per minute (BMI 170, 73 cm).
He had dysphonia, and the rest of the physical examination was normal.
A new nasoral-ingoscopic study was performed and an epithelial lesion with apparent subepithelial component was found in the middle and posterior thirds of the left vocal fold.
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A clinical picture was ordered, measuring blood glucose, creatinine, X-ray and tomography of the chest with results within the normal limits; the serum transaminases showed elevation and the right branch showed mild glycaemia.
Patient status regarding tuberculosis (PPD or Interferon-Gamma Release Assay) and HIV infection was not determined.
Based on the clinical history and the findings described, laryngoscopy microsurgery was performed, in which samples were taken for biopsy of the lesion described.
The surgical specimen was sent to pathology and in the evaluation of the tissue with the coloration of hematoxylin and eosin was reported defective mucosa and fibroconjunctive tissue compromised by a granulomatous reaction center of Gram-negative bacilli.
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A new laryngoscopy was scheduled and samples were taken for mycobacterial culture and for the pertinent molecular studies.
The culture in Löstein-Jensen medium showed evidence of growth 18 days after inoculation with the presence of solid white colonies with a cerebraloid appearance, the ZNARs showed AFB staining with white color.
Sample analysis by PCR for amplification of the IS6110 fragment (M. tuberculosis complex specific) was positive.
Sensitivity studies were performed and sensitivity to all first-line anti-tuberculosis drugs was demonstrated.
Management began using the Directly Treatment (DOTS) strategy, Short -course with rifampicin, isoniazid, and pyrazinamide was cured for two months and rifampicin and isoniazid for four months.
