Tubercular Mediastinal Lymphadenopathy Presenting as Hoarseness of Voice Confirmed by Endoscopic Ultrasound

Hoarseness of voice due to unilateral vocal cord palsy as the first clinical presentation of tuberculosis (TB) has been rarely reported. A 15-year-old female presented with a sole history of hoarseness of voice for the past 4 months. Axial computed tomography (CT) at the level of vocal cords revealed dilation of the left laryngeal ventricle with ipsilateral deviation of arytenoid cartilage (sail sign), suggestive of left vocal cord palsy. Thoracic CT revealed multiple necrotic mediastinal lymphadenopathy, which on endoscopic ultrasound-guided biopsy confirmed TB. She was started on regular antitubercular therapy, and her voice significantly improved after 1 month.