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July 11, 2019

Congenital Tuberculosis With Oropharyngeal Mass Presenting as Neonatal Stridor

Author Affiliations
  • 1Department of Otorhinolaryngology–Head and Neck Surgery, University of Malaya, Kuala Lumpur, Malaysia
  • 2Department of Otorhinolaryngology–Head and Neck Surgery, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
JAMA Otolaryngol Head Neck Surg. Published online July 11, 2019. doi:10.1001/jamaoto.2019.1708

Neonatal stridor owing to congenital causes can be potentially life threatening. We describe a neonate who presented with stridor and signs of respiratory distress owing to oropharyngeal tuberculoma with underlying congenital tuberculosis (TB). To our knowledge, this extremely rare presentation of congenital TB is the first described in the literature and warrants attention in TB-endemic regions around the world.

A male neonate, born via normal delivery, presented with inspiratory stridor at 6 hours of life. He had a birth weight of 2.98 kg, and his mother had no significant antenatal medical history. On examination, he had respiratory distress and had to be put on nasal continuous positive airway pressure in the neonatal intensive care unit. His cry was normal. Other systemic examination revealed normal findings. Full blood cell counts did not reveal signs of sepsis, but chest radiographic findings showed haziness over the right lower zone. Flexible nasopharyngolaryngoscopy discovered a yellowish mass arising from the soft palate, which occupied the nasopharynx causing partial obstruction over the posterior choanae (Figure 1). Because the lesion had no connection to the nasopharynx and intracranium, the child underwent direct laryngoscopy, telebronchoscopy, and debulking of oropharyngeal mass under general anesthesia. Most of the mass was debulked and sent for histopathologic examination. Rigid laryngotracheobronchoscopic findings ruled out subglottic or tracheal stenosis. Mobility of the vocal cords was normal, no redundant supraglottic structures or webbing were seen, and no other synchronous lesions were detected. To our surprise, a histopathologic examination revealed chronic granulomatous inflammation, suggestive of TB, with acid-fast bacilli stain also showing positive results (Figure 2). His mother had positive TB contact from her cousin who had pulmonary TB. Eventually, the child was treated for congenital TB and began treatment with antituberculous medication. Postoperatively, the child was able to be weaned off oxygen and discharged. The oropharyngeal tuberculoma subsided after 9 months of medical treatment.

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