Laryngeal Mycobacterium bovis: A Unique Cause of Airway Compromise in a 27-Year-Old Male With Down Syndrome.

Introduction

Laryngeal tuberculosis (TB) due to Mycobacterium bovis is an extremely rare cause of airway obstruction. This case report describes a unique instance of acute airway obstruction in an immunocompetent 27-year-old male with down syndrome caused by laryngeal Mycobacterium bovis, shedding light on the challenges of diagnosis and treatment. Case: A 27-year-old male with trisomy 21 presented with progressive shortness of breath, productive cough, dysphonia, and dysphagia. After a failed workup for pneumonia and other conditions, imaging revealed likely epiglottitis and a right upper lung lesion. A tracheostomy was performed due to worsening airway compromise. Biopsy results confirmed granulomatous inflammation and identified Mycobacterium bovis, which was resistant to pyrazinamide. The patient was treated with a modified RIPE regimen and successfully decannulated 2 months later.

Conclusion

This case emphasizes the importance of a comprehensive diagnostic approach, including tissue biopsy and culture, in patients with airway compromise of unclear etiology. Mycobacterium bovis, though rare, should be considered in the differential diagnosis of laryngeal TB, especially in cases with progressive symptoms and atypical findings. Early recognition and tailored treatment are critical for favorable outcomes.