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Laryngeal tuberculosis (TB) is a rare extrapulmonary manifestation of TB. Patients often present with non-specific laryngeal complaints and may not have pulmonary TB, which was previously almost always associated with laryngeal TB. This case report describes a patient who initially presented with non-specific symptoms of chronic voice hoarseness and dry cough, who was initially diagnosed with pneumonia. Subsequent otorhinolaryngological evaluation was performed, which showed exudative laryngeal lesions with edema and narrowing of the supraglottis and glottis. The patient underwent urgent fiberoptic intubation to secure the airway, followed by a panendoscopy and biopsy of the laryngeal lesions. Microbiological testing and histopathological examination confirmed the diagnosis of laryngeal TB. The patient was also noted to have pulmonary TB involvement on chest radiographs. The patient was noted to have poorly controlled diabetes mellitus that was newly diagnosed, which is a significant risk factor for laryngeal TB. This case report highlights the ease of misdiagnosis and provides clinicians with a review of the epidemiology, clinical characteristics, diagnostic evaluation, and management of laryngeal TB. Additionally, it draws attention to the possibility of acute airway compromise in laryngeal TB, which is not widely reported in the literature. Laryngeal TB remains a relevant differential diagnosis for patients with chronic laryngeal symptoms, and clinicians should not exclude TB as a diagnosis even in developed or non-endemic regions.