S Tuberculous Laryngitis -A Case Presentation- Supervised by : Dr H.Oscar Djauhari, Sp. THT-KL Presented by : Florencia (2012 061 046) Clinical Rotation Otolaryngology, Head and Neck Surgery Department Medical Faculty of Unika Atma Jaya Syamsudin, S.H. Regional General Hospital, Sukabumi December 1 st , 2014 – January 3 rd , 2015
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S
Tuberculous Laryngitis
-A Case Presentation-Supervised by :
Dr H.Oscar Djauhari, Sp. THT-KL
Presented by :Florencia (2012 061 046)
Clinical RotationOtolaryngology, Head and Neck Surgery Department
Medical Faculty of Unika Atma JayaSyamsudin, S.H. Regional General Hospital, Sukabumi
December 1st, 2014 – January 3rd, 2015
Patient’s Identity
Name : Mr. Y Age : 55 years old Sex : Male Race : Javanese Address : Babakan Bandung, Sukabumi Weight : 50 kg Height : 170 cm
History of Illness
Chief complaint : Sudden hoarseness and difficulty swallowing
Additional complaints : Persistent with bloody cough, neck mass, and weight
loss
History of present illness
Patient came with sudden hoarseness and difficulty in swallowing. He had a persistent cough for about a year, he had received a medication for his cough but never had any improvement. Bad cough came with productive phlegm that was green in color, sometime with a stain of redness in it. The phlegm got often swallowed by the patient. The cough was progressively worsening. Patient also had a weight loss for around 15 kilos in the last 1 year. He smoked 1 pack a day for 25 years
History of past illness
There’s history of diabetes mellitus No history of hypertension No history of cerebrovascular disease No history of trauma Family’s History No history of malignancy in his
family
Physical Examination
General appearance : calm Consciousness : compos mentis Blood pressure : 120/70 mmHg Pulse rate : 80 x/min Respiratory rate : 24 x/min Body temperature : 37,4 C
Physical Examination
Pulmonal Inspection: breathing looks symmetric on both side
of the lung in static and dynamic condition Palpasion : stem fremitus in right lung increased Percussion: dull sound in apex region of the right
lung Ausculttation : Ronchi +/+ , wheezing -/-
ENT Examination Right Ear
Auriculae : normal CAE : mucous membrane hyperemic (-), edema (-), mass (-),
secretion (-), laceration (-), cerumen (-) Tymphanic Membrane : intact, bulging (-), Light reflex (+) Rinne test (+), weber test no lateralization, normal Schwabach test
Left Ear Auriculae : normal CAE : mucous membrane hyperemic (-), edema (-), mass (-),
secretion (-), laceration (-), cerumen (-) Tymphanic Membrane : intact, bulging (-), Light reflex (+) Rinne test (+), weber test no lateralization, normal Schwabach test
ENT Examination
Right nose Mucous membrane : hyperemic (-), edema (-),
secretion (-), mass (-), laceration (-), crust (-) Concha : eutrophy Septum : no deviation Air passage : normal
Left nose Mucous membrane : hyperemic (-), edema (-),
secretion (-), mass (-), laceration (-), crust (-) Concha : eutrophy Septum : no deviation Air passage : normal
ENT Examination
Throat : Uvula : in the middle Pharynx : normal pharyngeal arch, hyperemic (-) Tonsil : T1/T1, enlarged crypt (-), detritus (-)
Neck : Lymphadenopathy at right upper clavicle lymph
node
Planning
Laboratory finding ( complete blood count ) Chest radiograph PA position Mantoux test Sputum test Direct laryngoscopy
Workup
Laboratory
Workup
Plain chest x-ray PA position
CXR result : active Tuberculosis on the right lung
Working Diagnosis
Chronic Laryngitis ec suspect lung tuberculosis
Therapy
To treat tuberculosis : Rifampisin 450 mg ( 1 time a day ) INH 300 mg ( 1 time a day ) Pirazinamid 500 mg ( 2 times a day ) Ethambuthol 500 mg ( 1 time a day )