Authors : Amit Kumar Verma, Alpana Singh, Sugandha Dev
DOI : 10.18231/j.ijogr.2019.120
Volume : 6
Issue : 4
Year : 2019
Page No : 554-556
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.
Keywords: Laryngeal TB, Pregnancy, Aphonia.