Laryngeal tuberculosis presenting as an isolated vocal cord lesion in an immunocompetent patient: a case report

Laryngeal tuberculosis (TB), once a common complication of pulmonary TB, has become rare in the antibiotic era but remains an important diagnostic consideration in endemic regions, particularly in patients presenting with persistent hoarseness. While historically associated with advanced pulmonary disease, isolated laryngeal TB can occur even in immunocompetent individuals without systemic symptoms or radiographic evidence of lung involvement. Due to its nonspecific presentation—often mimicking malignancy or chronic laryngitis—misdiagnosis is common, delaying appropriate treatment. This case highlights an atypical manifestation of laryngeal TB as a solitary vocal cord ulcer in a healthy, non-immunocompromised woman, emphasizing the importance of histopathological confirmation and early anti-tubercular therapy for optimal outcomes. We present a case of a 33-year-old immunocompetent Ethiopian woman with a six-month history of hoarseness and reduced appetite, without constitutional symptoms or pulmonary involvement. Indirect laryngoscopy revealed an ulcerated mass on the right vocal cord, while a tuberculin skin test showed a strong positive reaction (15 mm induration). Histopathological evaluation of the vocal cord biopsy revealed caseating granulomas with Langhans giant cells, confirming the diagnosis of laryngeal tuberculosis. AFB staining from tissue showed rod-shaped bacilli consistent with Mycobacterium tuberculosis, and GeneXpert testing verified tuberculosis without resistance to isoniazid or rifampicin. The patient showed an excellent response to standard anti-tubercular therapy, with full resolution of symptoms and complete vocal cord healing observed on follow-up laryngoscopy. This case underscores the need to consider TB even in isolated laryngeal lesions, particularly in TB-endemic areas, as early diagnosis and treatment ensure favorable outcomes. Not applicable.