Коморбидность во фтизиатрической практике: мультирезистентный туберкулез и рак гортани (2 клинических случая)

Abstract

A – research concept and design; B – collection and/or assembly of data; C – data analysis and interpretation; D – writing the article; E – critical revision of the article; F – final approval of the article. One of the factors undermining the effectiveness of treatment for tuberculosis patients is comorbid diseases, especially oncopathology. The study on features of laryngeal cancer and pulmonary multidrug-resistant tuberculosis (MDR-TB) co-existence and diagnosis is relevant in this regard, especially given the fact that patients with laryngeal tuberculosis can be easily misdiagnosed with cancer. The purpose is to familiarize practitioners with the clinical features and diagnosis of pulmonary MDR-TB comorbid with laryngeal cancer. Materials and methods. The article describes two clinical cases of pulmonary MDR-TB comorbid with laryngeal cancer based on our own clinical experience. Results. The course of laryngeal cancer depends on its localization in one of the 3 anatomical sites of the larynx. Thus, in the first case, there was squamous cell cancer of the laryngeal vestibule, characterized by progressive malignancy and aggressive metastasis. Both comorbidities have caused the imminent death in patient after 24 days of diagnosis. Laryngeal squamous cell cancer in the glottic anatomical region, diagnosed in the second case, was characterized by a more favorable course of the comorbidities. Conclusions. Pulmonary MDR-TB and laryngeal squamous cell carcinoma comorbidity is not only factor undermining the treatment effectiveness but also a cause of mortality in patients. Practitioners should have a high index of suspicion for the timely and differential diagnosis of laryngeal squamous cell carcinoma and laryngeal tuberculosis in MDR-TB patients. In that regard, it is worth noting that in patients (especially with a long-standing history of heavy cigarette smoking) having laryngeal complaints (swallowing difficulty, pain or discomfort in swallowing, hoarseness) and a neck mass, as a minimum, there is a need to perform the following diagnostic maneuvers: laryngoscopy, laryngoscopic biopsy, computed tomography of laryngopharynx (if not possible – conventional laryngeal radiography), fibrobronchoscopy, mycobacterium tuberculosis and atypical cells identification based on the results of sputum and / or bronchial aspirate examination. An otolaryngologist and oncologist consultation is mandatory for these patients.