Content area
Full Text
(ProQuest: ... denotes non-US-ASCII text omitted.)
Introduction
Hoarseness through direct involvement of laryngeal structures can be caused by Mycobacterium tuberculosis.1,2 Whilst uncommon in the UK, this presentation is well recognised in Southern Asia and elsewhere in the world. The occurrence of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome has increased the incidence of opportunistic infections, including those due to mycobacteriae.3,4 Hoarseness can also be caused by involvement of structures elsewhere within the thorax. In the UK setting, lung neoplasia would be a common cause of hoarseness and recurrent laryngeal nerve involvement. Mycobacterium tuberculosis rarely causes vocal fold paralysis due to left recurrent laryngeal nerve palsy.5,6 No previously published report of hoarseness or left recurrent laryngeal nerve palsy caused by Mycobacterium kansasii could be found.7-9 Here, we report briefly an unusual and instructive case.
Case report
A 57-year-old Caucasian man presented with a one-week history of productive cough, fever and hoarseness. There was no reported haemoptysis. He was a smoker and had recently lost 14 kg in weight.
A chest X-ray showed patchy shadowing in the upper and middle zones of the right lung. A sputum sample was positive on direct microscopy for acid fast bacilli. The patient was HIV negative.
The patient was treated initially with Rifater (rifampicin, isoniazid and pyrazinamide; Sanofi-Aventis Ltd, Guildford, United Kingdom) and ethambutol, and his fever gradually settled. Mycobacterium kansasii was isolated by the Health Protection Agency Mycobacterial Reference Laboratory. The organism was sensitive to the patient's antimycobacterial treatment.
At ENT review six weeks later, the patient was still hoarse. Nasoendoscopy showed partial paralysis with diminished movement of the left vocal fold. A computed tomography (CT) scan showed...