Tuberculous Laryngitis

-A Case PresentationSupervised by :
Dr H.Oscar Djauhari, Sp. THT-KL
Presented by :
Florencia (2012 061 046)

Clinical Rotation
Otolaryngology, Head and Neck Surgery Department
Medical Faculty of Unika Atma Jaya
Syamsudin, S.H. Regional General Hospital, Sukabumi
December 1st, 2014 January 3rd, 2015

Patients Identity

S Name

: Mr. Y

S Age

: 55 years old

S Sex

: Male

S Race

: Javanese

S Address

: Babakan Bandung, Sukabumi

S Weight

: 50 kg

S Height

: 170 cm

History of Illness

S Chief complaint

S Sudden hoarseness and difficulty swallowing

S Additional complaints

S Persistent with bloody cough, neck mass, and weight loss

History of present illness

S Patient came with sudden hoarseness and difficulty in

swallowing. He had a persistent cough for about a year,

he had received a medication for his cough but never had
any improvement. Bad cough came with productive
phlegm that was green in color, sometime with a stain of
redness in it. The phlegm got often swallowed by the
patient. The cough was progressively worsening. Patient
also had a weight loss for around 15 kilos in the last 1
year. He smoked 1 pack a day for 25 years

History of past illness

S Theres history of diabetes mellitus

S No history of hypertension
S No history of cerebrovascular disease
S No history of trauma
S Familys History No history of malignancy in his family

Physical Examination

S General appearance

: calm

S Consciousness

: compos mentis

S Blood pressure

: 120/70 mmHg

S Pulse rate

: 80 x/min

S Respiratory rate

: 24 x/min

S Body temperature

: 37,4 C

Physical Examination

S Pulmonal
S Inspection: breathing looks symmetric on both side of the

lung in static and dynamic condition

S Palpasion
: stem fremitus in right lung increased
S Percussion: dull sound in apex region of the right lung
S Ausculttation : Ronchi +/+ , wheezing -/-

ENT Examination
S Right Ear
S Auriculae : normal
S CAE

: mucous membrane hyperemic (-), edema (-), mass (-),

secretion (-), laceration (-), cerumen (-)
S Tymphanic Membrane : intact, bulging (-), Light reflex (+)
S Rinne test (+), weber test no lateralization, normal Schwabach test
S Left Ear
S Auriculae : normal
S CAE

: mucous membrane hyperemic (-), edema (-), mass (-),

secretion (-), laceration (-), cerumen (-)
S Tymphanic Membrane : intact, bulging (-), Light reflex (+)
S Rinne test (+), weber test no lateralization, normal Schwabach test

ENT Examination
S Right nose
S Mucous membrane : hyperemic (-), edema (-), secretion (-),
mass (-), laceration (-), crust (-)
S Concha : eutrophy
S Septum : no deviation
S Air passage : normal
S Left nose
S Mucous membrane : hyperemic (-), edema (-), secretion (-),
mass (-), laceration (-), crust (-)
S Concha : eutrophy
S Septum : no deviation
S Air passage : normal

ENT Examination

S Throat :
S Uvula : in the middle
S Pharynx : normal pharyngeal arch, hyperemic (-)
S Tonsil : T1/T1, enlarged crypt (-), detritus (-)

S Neck :
S Lymphadenopathy at right upper clavicle lymph node

Planning

S Laboratory finding ( complete blood count )

S Chest radiograph PA position

S Mantoux test
S Sputum test
S Direct laryngoscopy

Workup

S Laboratory

Workup
S

Plain chest x-ray PA position

CXR result : active Tuberculosis on the right lung

Working Diagnosis

S Chronic Laryngitis ec suspect lung tuberculosis

Therapy

S To treat tuberculosis :
S Rifampisin 450 mg ( 1 time a day )
S INH 300 mg ( 1 time a day )
S Pirazinamid 500 mg ( 2 times a day )
S Ethambuthol 500 mg ( 1 time a day )

Discussion
S