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Hoarseness due to Mycobacterium kansasii

Published online by Cambridge University Press:  15 August 2008

D Wray ,
M O Oko ,
D A R Boldy  and
M T Butt
D Wray*
Affiliation:
Department of ENT, Pilgrim Hospital, Boston, UK
M O Oko
Affiliation:
Department of ENT, Pilgrim Hospital, Boston, UK
D A R Boldy
Affiliation:
Department of Medicine, Pilgrim Hospital, Boston, UK
M T Butt
Affiliation:
Department of Radiology, Pilgrim Hospital, Boston, UK
*
Address for correspondence: Dr D Wray, 8 The Dene, Chowns Hill, Hastings TN35 4PD, UK. Fax: 01424 758132 E-mail: davidwray5@fsmail.net
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Abstract

Objective:

To present a case of unilateral vocal fold paralysis due to Mycobacterium kansasii induced pressure on the left recurrent laryngeal nerve, a specific aetiology not previously reported in the world literature.

Case report:

A 57-year-old Caucasian man presented with a short history of productive cough, fever, hoarseness and 14-kg weight loss. He was a smoker, had an abnormal chest X-ray and was human immunodeficiency virus negative. A sputum sample was positive on direct microscopy for acid fast bacilli. Initially, the patient was treated with Rifater (rifampicin, isoniazid and pyrazinamide) and ethambutol. Mycobacterium kansasii was isolated and proved sensitive to this antimycobacterial treatment. Nasoendoscopy revealed diminished movement of the left vocal fold, and a computed tomography scan showed enlarged mediastinal lymph nodes anterior to the aortic arch. After three months of antimycobacterial treatment, the vocal folds were fully mobile at repeat nasoendoscopy, and this coincided with gradual resolution of the patient's hoarseness and weight loss.

Conclusions:

There are many causes of unilateral vocal fold paralysis. This case illustrates the importance of anatomical knowledge in reaching a diagnosis, and also presents the first reported case of Mycobacterium kansasii creating this clinical picture.

Keywords

Vocal Cord ParalysisMycobacterium KansasiiRecurrent Laryngeal Nerve Palsy
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 5 , May 2009 , pp. 569 - 571
Copyright
Copyright © JLO (1984) Limited 2008

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References

1 Vyravanathan, S. Hoarseness in tuberculosis. J Laryngol Otol 1983;97:523–5CrossRefGoogle ScholarPubMed
2 Yew, WW, Chau, CH, Lee, J, Wong, PC, Leung, CK. Hoarseness due to recurrent laryngeal nerve palsy from intrathoracic mycobacteriosis. Int J Tuberc Lung Dis 2001;5:1074–5Google ScholarPubMed
3 eMedicine [homepage on the Internet]. Medical topics: Mycobacterium Kansasii. http://www.emedicine.com/med/topic1537.htm [4 March 2008]Google Scholar
4 Griffith, DE. Management of disease due to Mycobacterium kansasii. Clin Chest Med 2002;23:613–21CrossRefGoogle ScholarPubMed
5 Gupta, SK. The syndrome of spontaneous laryngeal palsy in pulmonary tuberculosis. J Laryngol Otol 1960;74:106–13CrossRefGoogle ScholarPubMed
6 Raj, B, Bihari, K, Kumar, P, Chawla, RK, Janmeja, AK, Chopra, RK. Unilateral vocal cord paralysis – unusual sequelae of healed pulmonary tuberculosis. Indian Journal of Tuberculosis 1987;34:150–2Google Scholar
7 Evans, SA, Colville, A, Evans, AJ, Crisp, AJ, Johnston, IDA. Pulmonary Mycobacterium kansasii infection: comparison of the clinical features, treatment and outcome with pulmonary tuberculosis. Thorax 1996;51:1248–52CrossRefGoogle ScholarPubMed
8 Maliwan, N, Zvetina, JR. Clinical features and follow up of 302 patients with Mycobacterium kansasii pulmonary infection: a 50 year experience. Postgrad Med J 2005;81:530–3CrossRefGoogle ScholarPubMed
9 Joint Tuberculosis Committee of the British Thoracic Society. Management of opportunist mycobacterial infections: Joint Tuberculosis Committee guidelines 1999. Prepared by a Subcommittee of the Joint Tuberculosis Committee of the British Thoracic Society. Thorax 2000;55:210–18CrossRefGoogle Scholar
10 Shah, P, Ramakantan, R. Hoarseness of the voice due to left recurrent laryngeal nerve palsy in tuberculosis mediastinitis [letter]. Arch Otolaryngol Head Neck Surg 1990;116:108CrossRefGoogle ScholarPubMed
11 Barnett, GC, Smith, IE, Wells, FC, Shneerson, JM. Vocal fold palsy due to plombage for tuberculosis. J Laryngol Otol 2005;119:138–9CrossRefGoogle ScholarPubMed
12 Sinnatamby, CS. Last's Anatomy: Regional and Applied, 10th edn. London: Churchill Livingstone, 1999Google Scholar
13 Blue, ML, Payne, WG, Mannari, RI, Moffitt, MR, Walusimbi, MG, Robson, MC. Mycobacterium kansasii causing carpal tunnel syndrome. South Med J 2002;95:1095–8CrossRefGoogle ScholarPubMed