Indian Journal of Obstetrics and Gynecology Research 2019;6(4):554–556 Content available at: iponlinejournal.com Indian Journal of Obstetrics and Gynecology Research Journal homepage: www.innovativepublication.com Case Report Aphonia in pregnancy: Pulmonary TB with laryngeal involvement Amit Kumar Verma 1 , Alpana Singh 2, *, Sugandha Dev 2 1 Dept. of Medicine, TB & Chest Division, UCMS & GTB Hospital, Delhi, India 2 Dept. of Obstetrics & Gynaecology, UCMS& GTB Hospital, Delhi, India ARTICLE INFO Article history: Received 14-05-2019 Accepted 09-09-2019 Available online 06-12-2019 Keywords: Laryngeal TB Pregnancy Aphonia ABSTRACT A primigravida 28 yr old female reported in gynaecology casualty at a period of gestation of 33 weeks and 4 days with complains of dry cough for 2 weeks , breathlessness for 1 month and aphonia for 4 months. On examination her vitals were stable , she had minimal crepitations on left side on chest auscultation. On per-abdominal examination the uterus was relaxed, of 32 weeks in size with cephalic presentation and fetal heart rate of 142 beats per minute . She had a chest x-ray suggestive of consolidation in left lower lobe. Medicine opinion was taken and she was treated for lower respiratory tract infection. Otorhinolaryngologist opinion was taken and on indirect laryngoscopy there was moth eaten appearance of vocal cords, arytenoids were bulky and congested, inter-arytenoid mamillation was present and congestion of aryepiglottic folds and posterior larynx was present. A provisional diagnosis of pulmonary T.B with laryngeal involvement was made. A diagnosis of Pulmonary T.B with laryngeal involvement was made and patient was started on prednisolone tablet 20 mg once daily along with ATT. Betamethasone cover was given and induction of labor was done at 35 weeks of gestation with cerviprime gel due to severe oligohydramnios. Then cesarean section was done in view of meconium stained liquor with fetal tachycardia. A male baby of 2.4 kg was delivered and baby was started on syrup isoniazid in prophylactic dose. On post-operative day 5 patient had severe breathlessness. Tracheostomy and intubation was advised but patient got relieved and maintained saturation on high flow oxygen. At post-operative day 8 patient regained her voice after 4 months, was able to communicate and was symptomatically better. She was discharged with baby with stable vitals on tablet prednisolone and ATT. Patient was asked to follow-up with the otorhinolaryngologist and medicine department. © 2019 Published by Innovative Publication. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by/4.0/) 1. Introduction Tuberculosis is caused by mycobacterium which causes chronic granulomatous infection by cell mediated immunity. It is one of the major health problems in developing countries like India. Most commonly it affects the lung ; however it can affect other organs too. During pregnancy tuberculosis (T.B) rarely affects larynx. 1 Laryngeal T.B is most commonly associated with pulmonary T.B. Previously it was thought that the mode of infection was direct spread along airway mostly to the posterior larynx but any region of the larynx can be involved due to primary infection by * Corresponding author. E-mail address: dralpanasingh@gmail.com (A. Singh). inhaled bacilli 2,3 Primary laryngeal involvement has been observed in 19% of cases and in 15-37% of the cases it is associated with pulmonary tuberculosis. Incidence of tuberculosis is now on a rise due to increase in incidence of immuno-suppressive states. 3 The goal of this report is to describe a case of pulmonary T.B with laryngeal involvement in a pregnant patient highlighting the need for keeping a high degree of suspicion in lesion of upper airways for early diagnosis in high prevalence areas of T.B. 2. Case Report A primigravida 2 8yr old female reported in gynaecology casualty at a period of gestation of 33 weeks and 4 days https://doi.org/10.18231/j.ijogr.2019.120 2394-2746/© 2019 Innovative Publication, All rights reserved. 554