Primary nasal tuberculosis

We present a case of a patient with primary nasal tuberculosis. Although this is a rare finding, it should be considered when a patient presents with a nasal obstruction. Smears for acid fast bacilli and cultures tend to be negative in nasal tuberculosis. Diagnosis is often based on histo- pathologic findings. Nasal TB is known to respond well to the regular treatment for (pulmonary) tuberculosis.     

Primary nasal Tuberculosis — A case report

During the past two decades, Tuberculosis — both pulmonary and extrapulmonary have re-emerged as a major health problem worldwide. Nasal tuberculosis may be primary, or secondary to pulmonary tuberculosis or facial lupus. However all of them are rare entities. Nasal tuberculosis should be considered in the differential diagnosis of chronic nasal granulomas. We report a case of primary nasal tuberculosis in an adult female who presented with a polypoidal lesion in the nasal cavity. The diagnosis was based upon smear study, histopathology, culture & polymerase chain reaction. The patient successfully responded to antituberculous therapy and is presently disease free. Given the resurgence of tuberculosis in recent times, it is important that otolaryngologists remain aware of this rare clinical entity.     

Primary nasal tuberculosis: a case report

During the past 2 decades, tuberculosis--both pulmonary and extrapulmonary--has re-emerged as a major health problem worldwide. Nasal tuberculosis--either primary or secondary to pulmonary tuberculosis or facial lupus--is rare, but it should be considered in the differential diagnosis of nasal granulomas. We describe a case of primary nasal tuberculosis in an adult male who presented with a polypoid lesion in one nasal cavity. The diagnosis was based on histopathology and the patient's successful response to antituberculous drug treatment. Given the rising incidence of tuberculosis, it is prudent that otolaryngologists remain cognizant of this infection as a potential cause of unusual lesions in the head and neck.     

Primary nasal tuberculosis-a rare clinical entity

Primary tuberculosis of the nose is very rare. We report a case of a 35-year-old woman who presented with bilateral nasal obstruction and epistaxis of 3 months' duration but who was otherwise healthy. She was diagnosed with primary nasal septal tuberculosis and was treated with antituberculosis DOTS (directly observed treatment, short course) therapy for 6 months with complete recovery. Given the resurgence of tuberculosis in recent times, it is important that clinicians remain aware of this rare and treatable clinical entity.     

Tuberculosis of paranasal sinuses

Nasal tuberculosis is very rare but much rarer is tuberculosis of paranasal sinuses. It involves especially the maxillary sinus and is usually unilateral. We report an unusual case of tuberculosis of frontal and maxillary sinus in a 68 years old male, who presented with a swelling above left medial canthus, with no other eye or nasal complaints. Clinical and radiological findings on our initial evaluation suggested that the patient had left frontal mucocoele with bilateral maxillary haziness. Diagnosis was established on FNAC report and subsequent Ziehl — Neelsen staining of nasal swabs and tuberculin skin test. Later chest x-ray examination was suggestive of pulmonary tuberculosis, which was the primary cause. Patient responded well to antituberculosis drug therapy.     

An unusual case of primary nasal tuberculosis with epistaxis and epilepsy

Primary nasal tuberculosis is rare. We report a case that was all the more extraordinary because of the age and sex of the patient (an 11-year-old boy), the unusual associated symptoms (epistaxis and grand and seizures), and the presence of intracranial extension. Clinical and radiologic findings on our initial evaluation suggested that the patient had a large sinonasal malignancy. The patient manifested no evidence of pulmonary tuberculosis. The diagnosis of primary nasal tuberculosis was established only after we obtained the results of histopathology of the excised mass and a subsequent tuberculin skin test; the diagnosis was confirmed by the patient's rapid response to antituberculosis drug therapy. We also review the relevant literature on this rare condition.     

Nasal tuberculosis: A forgotten entity

Tuberculosis of the nose has become so infrequent that it is virtually a forgotten disease entity among younger practitioners in this country. Nevertheless, it can occur in all segments of our population and may present a confusing diagnostic problem. Two cases of primary nasal tuberculosis have been diagnosed and treated at The Cleveland Clinic Foundation since 1975. The differential diagnosis of nasal granulomatous disease usually includes Wegener's granulomatosis, midline malignant reticulosis, and sarcoidosis. We point out the necessity of including tuberculosis in this differential diagnosis. The definitive work-up and treatment are also discussed.     

Primary nasal tuberculosis with lacrimal drainage involvement

Primary tuberculosis of the nasolacrimal system is a rare entity. We report two cases of nasal tuberculosis from an endemic area who presented with epiphora as the only symptom. Both cases had no nasal symptoms, no cervical lymph nodes involvement and no evidence of pulmonary tuberculosis. Histopathology of biopsy from nasal mucosa in both cases was consistent with tuberculosis. Tuberculin test and Quantiferon TB-Gold test were positive. The patients were treated with anti tubercular therapy along with endoscopic dacryocystorhinostomy. At three months post-operative follow up epiphora resolved and patients were asymptomatic.     

Primary nasal tuberculosis: a case report

We report a case of a 36 year old woman who presented a chronic rhinitis and a hypertrophy of the inferior turbinates. Primary nasal tuberculosis was discovered by chance after the inferior turbinectomy. Primary nasal tuberculosis is very rare and is more frequent in women. Symptomatology is often unilateral with nasal obstruction, anterior rhinorrhea or epistaxis. The clinical examination may discover ulceration or a polyp located generally in the nasal septum or the inferior turbinate. Diagnosis relies on the anatomopathologic and bacteriological examinations. The treatment is mainly medical based on antituberculosis drugs. In the light of this case report, a review of the literature was made.     

Primary nasal tuberculosis: a forgotten disease?

Nasal tuberculosis represents a rare manifestation of infection by Mycobacterium tuberculosis. Clinically, it appeared to resemble cancer presenting as a nasopharyngeal mass with concomitant enlarged lymph nodes. It is important to consider tuberculosis in the differential diagnosis of all nasopharyngeal lesions and take biopsy samples for histological and bacteriological studies. Antituberculosis treatment is satisfactory with standard anti-tuberculous chemotherapy. Although this is a rare finding, it should be considered when a patient presents with nasal obstruction.     

Primary nasopharyngeal tuberculosis in a patient with the complaint of snoring

Isolated nasopharyngeal tuberculosis is a rare condition, even in endemic tuberculosis areas. The most common presentation of nasopharyngeal tuberculosis is with a cervical lymphadenopathy followed by nasal discharge or obstruction. Here we present a 58-year-old patient with nasopharyngeal tuberculosis whose only complaint was snoring. Her oropharyngeal and anterior rhinoscopic examination was normal. On endoscopic examination, mucosal oedema and hyperaemia of the nasopharynx was observed. There was no cervical lymphadenopathy. The tuberculin skin test was positive and histopathological examination of the biopsy taken from posterior nasopharyngeal wall supported the diagnosis of tuberculosis. After anti-tuberculosis therapy, the snoring stopped and the nasopharyngeal examination was normal.     

The disappeared disease: tuberculosis of the nasal septum

Recent advances in chemotherapy have reduced the incidence of upper respiratory tract tuberculosis. Tuberculosis of the nose is mainly by secondary infection to pulmonary tuberculosis via contagious, hematogenous or lymphatic routes. Primary infection of the nose is rare but possible when self-cleansing mechanism and lysosomal activity, of the nose is lost. A 45-year-old Korean woman with the chief complaints of nasal obstruction, crusting, and recurrent episodes of epistaxis is presented. Physical examination of the nose revealed friable, easily bleeding masses with crusts on both sides of the septum. The appearance and consistency of the lesions were different from those of nasal polyps. Chest and sinu X-rays revealed no active lesions. Tuberculin skin test was positive and the biopsied specimen proved to be consistent with tuberculosis. Her condition improved after anti-tuberculous medication for about 6 months.     

Sarcoidosis of the nose and paranasal sinuses

Sarcoidosis is a chronic systemic disease of unknown etiology characterized by non-caseating granulomatous inflammation of various organs. The records of 2319 patients with the diagnosis of sarcoidosis were reviewed to determine the incidence of nasal involvement. Seventeen patients or approximately 1% of the patients with sarcoidosis had histologically proven nasal mucosa involvement. These patients had symptoms of nasal crusting, congestion, epistaxis, pain, or anosmia. The clinical findings in these patients included friable nasal mucosa, nasal polyps, or a characteristic submucosal nodularity. Most patients also had abnormal sinus roentgenograms with either thickening of the sinus mucosa or opacification of the sinuses. Biopsy of the nasal mucosa shows typical non-caseating granulomas, but care must be exercised to exclude other causes of granulomatous inflammation of the nasal mucosa including tuberculosis, fungal infections, and other idiopathic granulomatous diseases such as Wegener's granulomatosis and Churg-Strauss syndrome. The treatment of nasal sarcoidosis has consisted of systemic steroids and in some cases topical beclomethasone dipropionate.     

Nasal manifestation of extranodal Rosai-Dorfman disease--diagnosis and management.

Two cases of Rosai-Dorfman disease with polypoid nasal infiltration mimicking nasal tuberculosis and malignant lymphoma are reported. This rare benign disease was first described by Rosai and Dorfman in 1969 and is characterized by histiocytic proliferation. It is seldom considered in the differential diagnosis of granulomatous diseases due to its rarity and histological similarity to other diseases. Extranodal manifestations of this disease are uncommon. Although no specific treatment can guarantee a sustained remission of this disease, surgery for loco-regional lesions can result in long-term symptomatic control and restoration of function. Both patients underwent endoscopic resection of the nasal polypoid lesions and have subsequently been free of recurrence. Loco-regional infiltration of the nasal cavity by Rosai-Dorfman disease is effectively managed by endoscopic resection.     

Primary chordoma of the lateral nasal wall: case report and review

Chordomas are malignant, nonepithelial neoplasms derived from notochordal tissue. A primary chordoma of the nasal cavities and paranasal sinuses is extremely rare compared with clival chordomas, which often present as nasal masses after spreading anteriorly. Only a few cases of primary chordoma of the nasal cavities and paranasal sinuses have been reported in the literature. We report a case of a primary chordoma of the lateral nasal wall. Pathologic diagnosis was obtained using an intranasal endoscopic excision. As in our patient, a primary chordoma of the nasal cavity or paranasal sinuses may present with symptoms related to mechanical obstruction secondary to the tumor mass. We summarize our case in the context of the other reported cases, and we discuss treatment options, natural history, and prognosis.     

Congenital os vomer agenesis: case report and literature review

Defects of the nasal septum occur as a result of a variety of causes, including tuberculosis, irritation, neoplasia, trauma, infection, and chronic inflammatory diseases. Congenital os vomer agenesis as a cause is very rare. We report the case of a 28-year-old man with a defect in the posteroinferior part of the nasal septum that was discovered incidentally during a routine endoscopic examination. The patient was diagnosed with congenital os vomer agenesis, and the diagnosis was confirmed by computed tomography. We discuss the features of this case and review the literature on this rare anomaly.     

Primary oropharyngeal tuberculosis causing destruction of uvula—A rare presentation

Despite the contact of pulmonary secretions and the mucous membranes of the upper respiratory tract with a high bacillary load, tuberculosis of the head and neck area, excluding laryngeal forms, is exceptional and constitutes only 2–6% of extra pulmonary tuberculosis and 0.1–1% of all forms of tuberculosis. Oral cavity tuberculosis is uncommon, out of which primary pharyngeal tuberculosis is extremely rare. We present a case of an ulcerative lesion in a 7-year-old female subsequently proven to be primary oropharyngeal tuberculosis. There was an erosion of uvula and posterior soft palate. There was also an ulcerated area on adjacent area of left tonsillar fossa with slough over posterior pharyngeal wall.     

人鼻黏膜上皮细胞中白细胞介素12和细胞间黏附分子1及单核细胞趋化因子3的表达研究

目的:利用RT-PCR检测原代培养的人鼻黏膜上皮细胞中IL-12、细胞间黏附分子1(ICAM-1)以及单核细胞趋化因子3(MCP-3)mRNA的表达。方法:获取人鼻黏膜组织,原代培养人鼻黏膜上皮细胞。设计IL-12 p35亚基、IL-12 p40亚基I、CAM-1以及MCP-3的引物,参照物采用3-磷酸甘油醛脱氢酶(GAPDH),目标扩增片段938 bp。半定量RT-PCR检测其mRNA在鼻黏膜上皮细胞的表达。结果:×400光镜下观察结果显示原代培养的鼻黏膜上皮细胞形状呈圆形或不规则形,饱满贴壁。RT-PCR结果通过1%琼脂糖凝胶电泳显示,鼻黏膜上皮细胞有IL-12 p35I、CAM-1以及MCP-3 mRNA的表达,但无IL-12 p40亚基的表达。结论:人鼻黏膜上皮细胞中有IL-12 p35、ICAM-1以及MCP-3的mRNA表达,但无IL-12p40亚基的表达。人鼻黏膜上皮细胞不能合成完整有活性的IL-12。     

Pseudotumoral mycobacterial infection in the head and neck: a clinical study

The clinical aspects of mycobacterial infection of the head and neck are considered as presenting in patients at a cancer hospital over the last 15 years. Some difficulties in diagnosis with respect to the evolution of tuberculosis in this region are discussed. A total of 32 patients with evidence of infection were identified. Twenty-six of these with cervical lymphadenopathy are considered as a group; their clinical features and diagnosis are summarized and a note made of the recent change in the macroscopic quality of the nodes removed. Six cases are given particular attention: two with laryngeal tuberculosis, two with nasal or adenoidal infection and two with atypical mycobacterial infection diagnosed on clinical grounds.     

Revision septoplasty: review of sources of persistent nasal obstruction

BACKGROUND: Patients with nasal obstruction from septal deviation commonly undergo septoplasty to improve nasal airflow. Some patients suffer from persistent obstruction after their primary septoplasty and may undergo a revision septoplasty to improve their nasal passageway. Our objective was to identify patients who underwent revision septoplasty and to identify their sources of persistent nasal obstruction. METHODS: Patients who underwent septoplasty at our institution between 1995 and 2005 were reviewed. Data is collected on demographics, comorbidities, age at septoplasty, associated and concomitant procedures, surgical approach, and anatomic site of obstruction. RESULTS: Five hundred forty-seven patients met inclusion criteria including 477 who underwent primary septoplasty and 70 who underwent revision surgery. Nineteen percent of nonrevision patients underwent nasal valve surgery along with their primary septoplasty versus 4% of patients in the revision group. Fifty-one percent of revision patients had nasal valve surgery at revision surgery. Patients who underwent sinus surgery along with primary septoplasty were less likely to undergo revision septoplasty. History of facial trauma, obstructive sleep apnea, site of deviation, and performance of inferior turbinate surgery did not affect the likelihood of revision septoplasty. CONCLUSION: A significant number of patients who undergo revision septoplasty also have nasal valve collapse. We recommend that in addition to septal deviation and inferior turbinate hypertrophy, nasal valve function be fully evaluated before performing septoplasty. This will help to ensure a complete understanding of a patient's nasal airway obstruction and, consequently, appropriate and effective surgical intervention.