LARYNGEAL TUBERCULOSIS IN HIV-INFECTED PATIENTS - A DIFFICULT DIAGNOSIS

Unrecognized laryngeal tuberculosis (TB) poses a significant hazard to otolaryngologists. However, the changing manifestations of TB ill pat ients with human immunodeficiency virus (HIV) infection can make its d iagnosis difficult. In our population of 146 patients with TB involvin g the head and neck, HIV infection was present in 70 cases (48%), The prevalence of laryngeal TB in this population was 5.5% (8 patients), C oncomitant HIV infection was present in 2 (25%) of 8 patients with lar yngeal TB. A delay in the diagnosis of laryngeal TB occurred in 100% o f patients with HIV infection, compared with 17% of non-HIV-infected p atients (P = .055). The cause of the delayed diagnosis was multifactor ial, mainly the presence of multiple confounding variables and the car cinoma-like appearance of the laryngeal TB lesions in HIV-infected pat ients. To reduce risk for transmission of TB to health care providers, a high level of suspicion must be present for all patients with laryn geal lesions, especially those with HIV infection.