Pulmonary, Laryngeal TB in pregnancy Dx after failed trachea
The present case has been reported in the International Journal of Obstetric Anesthesia. A pregnant woman at 25 weeks of gestation was diagnosed with laryngeal tuberculosis following a failed intubation for upper gastrointestinal endoscopy.

Laryngeal tuberculosis represents approximately 1% of all cases of tuberculosis in the United States and presents a unique diagnostic challenge, because accompanying laryngeal changes are both varied and nonspecific. This report highlights both the challenges of the pregnant airway and the diagnosis and treatment of laryngeal tuberculosis.

Highlights of the case:-
• This case shows the importance of the clinical diagnosis of laryngeal tuberculosis.

• Laryngeal tuberculosis could lead to failed intubation, especially in pregnancy.

• The management of a difficult airway in the gastrointestinal suite.

A 35-year-old, gravida 2 para 1, female at 25 weeks of gestation was referred for an upper gastrointestinal endoscopy. She had a six week history of severe gastroesophageal reflux disease, hoarseness, odynophagia, and a 5.5 kg weight loss. A diagnosis of laryngopharyngeal disease, due to severe gastroesophageal reflux, had been made at an outpatient otolaryngology consultation.

She also reported a recent upper respiratory tract infection for which she had been empirically treated with azithromycin. Due to worsening odynophagia and weight loss she was admitted to the antepartum obstetric service for total parenteral nutrition and upper endoscopy, to confirm the diagnosis of esophagitis and microaspiration.

She had a cough, extreme weight loss, odynophagia, hoarseness and fatigue, but notably no history of fever, chills, night sweats, sputum production, nausea, vomiting, abdominal or chest pain, shortness of breath, recent travel or sick contacts.

She was a cachectic pregnant female who was 157 cm tall and weighed 44 kg. Her upper airway examination was unremarkable, with a Mallampati II view. There were mildly decreased breath sounds over the left lung base. An outpatient flexible laryngoscopy performed 24 h prior to consultation showed a moderately swollen epiglottis, swollen false vocal cords with adherent white plaques; normal, mobile and visible true vocal cords; and pooling secretions with visible aspiration.

A chest X-ray had not been performed because decreased breath sounds were thought to be secondary to the micro-aspiration noted on otolaryngology examination.

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