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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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