A70-19 Primary Infection of Drug-resistant Tuberculous Laryngitis in Immunocompromised Patient - A Rare Case Report

Abstract Background Tuberculosis (TB) remains a significant public health challenge, especially in immunocompromised individuals. Drug-resistant TB poses additional therapeutic obstacles, necessitating detailed case documentation and tailored treatment approaches. This case report presents a primary infection of drug-resistant laryngitis TB in an immunocompromised patient without traditional risk factors for extrapulmonary TB. Clinical Presentation A 64-year-old female presented with hoarseness of voice, significant weight loss, and odynophagia for six months. She has a known history of Systemic Lupus Erythematosus (SLE). Laryngoscopy showed cobble stone epiglottis and adduction paresis of the vocal cords. A biopsy of the epiglottis revealed chronic granulomatous inflammation on histopathological examination. Further tests, including the GeneXpert MTB/RIF assay, confirmed rifampicin resistance in the tissue biopsy sample. Thoracic CT scan showed tree-in-bud appearance and micronodules; however, the Acid-Fast Bacillus (AFB) test from sputum was negative. She was diagnosed with primary infection of drug-resistant laryngitis TB. Despite her immunocompromised status, she had no traditional risk factors for drug resistant tuberculosis. The patient was started on a short-term regimen including bedaquiline, levofloxacin, clofazimine, ethambutol, and ethionamide, to be administered over 9-11 months. A multidisciplinary team, which consisted of infectious disease specialists, pulmonologists, and immunology specialists, was involved in the patient’s treatment. Regular follow-ups and hospitalizations documented gradual improvement in her clinical status despite the complexity of her condition. Discussion This case draws attention to the unusual presentation of laryngeal TB, a rare form of extrapulmonary tuberculosis, especially in immunocompromised patients without typical risk factors. Laryngeal TB often mimics other conditions like laryngitis or malignancies, which can delay diagnosis and administration of appropriate treatment. The patient’s voice hoarseness and weight loss were initially nonspecific, but histopathological finding revealing granulomatous inflammation and GeneXpert MTB/RIF assay helped confirm the presence of TB in the larynx. Literatures indicate that drug-resistant laryngeal tuberculosis is rare case, particularly in patients without significant risk factors for drug-resistant tuberculosis. This case underscores the importance of considering TB in atypical sites for timely, targeted intervention and better outcomes. This abstract is funded by: None