Reactivation Tuberculosis Presenting With Oropharyngeal Manifestations

Abstract Introduction: Mycobacterium Tuberculosis (Tb) is a worldwide health issue with most cases occurring outside the United States. Prevention and control of Tb remains a vital component of Public Health, and here we present a case with rare manifestations of reactivation Tb. Description of Case: A 52-year-old Vietnamese man presented as a direct admission from the pulmonologist's office due to concern for active tuberculosis (Tb). He had reported symptoms of chronic cough, fevers, and weight loss over the previous 3-4 months, but also had months of odynophagia and dysphagia. Outpatient CT chest showed upper lobe predominant cavitary lesions and interferon-γ release assay was positive. He was admitted to the hospital for further workup. On presentation, he was noted to have leukoplakia. HIV testing was negative. Sputum for acid-fast bacilli (AFB) was smear positive, mycobacterium TB (MTB) PCR was positive, and rifampin resistance was negative. The patient on RIPE therapy for Tb. Oro-pharyngeal tuberculosis was considered possible, but micafungin was also initiated due to concern for possible associated esophageal candidiasis. Gastroenterology was consulted but an endoscopy was deferred due to the patient being actively treated for Tb. X-ray of the mandible was done, ruling out osteomyelitis from Tb. His symptoms improved after completing two weeks of inpatient RIPE therapy and empiric treatment with micafungin. Discussion: This case illustrates a patient who presents with both classic symptoms of reactivation Tb and potentially rare manifestations of the disease (oral leukoplakia, odynophagia, and dysphagia). His oral lesions were similar in description to those reported in other case reports of oral Tb, with dysphagia and odynophagia reported in 84% and 42%, respectively, of esophageal Tb cases. While biopsy of his lesions via EGD or laryngoscopy would have been confirmatory, his improvement in his dysphagia and odynophagia with RIPE therapy strongly suggests this was a case of oropharyngeal Tb. The public health implications of Tb remain significant both nationwide and worldwide and the identification of atypical presentations of Tb, such as dysphagia and odynophagia, can help with better infection control.