Hoarse voice: a rare presentation of tuberculosis lymphadenitis

A man aged 37 years from Indian descent presented to an inner city London hospital with hoarseness of voice, fatigue, night sweats and a 2 kg weight loss. Laryngoscopy demonstrated a left vocal fold palsy. Extensive investigations were undertaken with disseminated malignancy being primarily investigated. CT/MRI scanning showed non-specific necrotic mediastinal lymph nodes. Tuberculin skin testing, cytology and PCR were eventually undergone. Tests yielded results consistent with tuberculosis (TB) infection and the patient was started on standard TB treatment protocol, with excellent results. TB infection can result in multiple atypical presentations of disease, including hoarseness of voice secondary to vocal cord paralysis. This is a rare but important presentation for community clinician's to consider, especially in populations where TB is epidemiologically thought to be prevalent.