An Uncommon Presentation of a Common Disease: Hoarseness of Voice in a Young Patient With Tuberculosis

Pulmonary and extrapulmonary tuberculosis impose a major load of chronic disease burden. Lymph node and pleural tuberculosis are the most common types of extrapulmonary tuberculosis. Isolated hoarseness of voice is a rare presenting feature of lymph node tuberculosis. We present the case of a young girl who presented to us with the complaint of hoarseness of voice for two months. A contrast-enhanced CT of the neck and chest revealed bilateral cervical and mediastinal lymphadenopathy encroaching on the aortopulmonary window. A 70-degree rigid endoscopy revealed left vocal cord paralysis. A cervical lymph node excision biopsy showed necrotizing granulomatous inflammation and Langhan-type giant cells. The diagnosis was confirmed by culture on Löwenstein-Jensen medium and drug susceptibility testing, which identified Mycobacterium tuberculosis sensitive to all first-line antitubercular drugs. She was put on weight-based antitubercular therapy, after which her voice showed improvement, and she gained four kilograms. We present this case to highlight the importance of being familiar with uncommon presentations of common diseases, particularly in areas of high disease endemicity, to allow for timely diagnosis and treatment.