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

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.     

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.     

Primary nasal tuberculosis masquerading as a malignant tumour

Primary nasal tuberculosis is rare. We report a case of primary nasal tuberculosis in an elderly lady who presented with symptoms and signs suggestive of a nasal fossa tumour. Histological examination of the lesion revealed the diagnosis. Treatment was with standard anti-tuberculous chemotherapy. The implications of primary nasal tuberculosis are discussed.     

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.     

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.     

耳鼻咽喉及颈淋巴结结核的诊断：对临床表现的分析

总结２６例耳鼻咽喉和颈淋巴结结核，结合文献分析其临床表现的变化和诊断要点，发现与过去相比，其病变程度和局部、全身症状明显减轻；与肺结核的关系不如以前密切；原发性和血行播散性病变的比例增大；局部以肉芽或增殖性病变为主，溃疡或坏死性病变较轻，外观更象恶性肿瘤。在诊断上，熟悉此病临床表现的变迁，提高警惕性，是防止误诊和漏诊的重要方面。病理学检查仍是主要确诊手段；有时需反复多次活检才能确诊。对病理学难以确诊的病例，应做改良抗酸染色（ＩｎｔｅｎｓｉｆｉｅｄＫｉｎｙｏｕｎ，ＩＫ）或免疫组化染色，以检测常规病理学检查不易发现的Ｌ型菌；治疗试验有重要的辅助诊断价值。临床表现发生变迁的原因与结核菌Ｌ型可能有关。     

The rare case of primary isolated tuberculosis in a 19 year-old patient

Tuberculosis of the upper respiratory tract is not common at present and it is usually secondary to pulmonary tuberculosis. The rare case of isolated tuberculosis of the larynx in 19-year old patient was presented in this paper. The primary diagnosis was laryngitis chronica. Further investigations, especially biopsy and histopathological examination revealed the proper diagnosis. The patient was treated with tuberculostatics.     

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 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 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 tonsil associated with pulmonary foci

Tuberculosis of tonsil is one of the uncommon forms of extra pulmonary tuberculosis. We report a case of tuberculosis of tonsil associated with pulmonary foci. A 48-year-old male presented with history of severe left sided throat pain of 10–15 days duration and fever of moderate degree of 7 days duration. Clinical diagnosis of left peritonsillitis was made. As the symptoms did not subside with antibiotics and analgesics malignancy was suspected, biopsy was done under local anesthesia and sent for histopathology. Histopathology revealed tuberculosis. He was evaluated further and primary foci was found in lung. The possibility of tuberculosis should be considered in a case with unilateral severe throat pain with congested tonsil not responding to usual line of treatment.     

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.     

Nasopharyngeal tuberculosis

Nasopharyngeal tuberculosis is a rare disorder. It usually occurs via hematogenous and lymphatic spread from coexistent pulmonary or systemic tuberculosis, and by airway during respiration or bacillary expectoration. MATERIAL: we present a case of nasopharyngeal tuberculosis in a 50-year-old female patient presenting with a cervical mass and unilateral otitis media with effusion. The diagnosis was made by PCR and by isolation of Mycobacterium Tuberculosis on Loveinstein-Jensen cultures. CONCLUSION: Nasopharyngeal tuberculosis may present with cervical mass, unilateral otitis media with effusion, and may mimic nasopharyngeal carcinoma. Furthermore, nasopharyngeal carcinoma may harbor foci of granulomatous reaction, and this feature may confuse the pathologist. However PCR carries the advantage to detect the DNA of Mycobacterium tuberculosis before its growth on culture. Even though it is rare, this entity must be considered in the differential diagnosis of the nasopharyngeal masses.     

Tuberculosis of the nasopharynx: clinicopathological features

The clinicopathological features of 10 adult patients with nasopharyngeal tuberculosis (TB) are presented. 9 patients had no evidence of chest or systemic disease. 7 patients presented with cervical lymphadenopathy, and only 4 had nasal symptoms. Examination of the nasopharynx showed no abnormality in 2 patients, lymphoid hyperplasia in 4 patients, and a tumour-like mass in 4 patients. These findings suggest that nasopharyngeal TB may occur more frequently as part of an isolated upper respiratory tract infection than as secondary to pulmonary infection. The nasopharynx may be a portal of entry for tubercle bacilli in patients who develop cervical lymphadenitis. Involvement of the nasopharynx by TB may be underdiagnosed because it does not produce obvious symptoms or physical signs in all cases.     

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.     

Tuberculosis of the nasopharynx: clinicopathological features.

The clinicopathological features of 10 adult patients with nasopharyngeal tuberculosis (TB) are presented. 9 patients had no evidence of chest or systemic disease. 7 patients presented with cervical lymphadenopathy, and only 4 had nasal symptoms. Examination of the nasopharynx showed no abnormality in 2 patients, lymphoid hyperplasia in 4 patients, and a tumour-like mass in 4 patients. These findings suggest that nasopharyngeal TB may occur more frequently as part of an isolated upper respiratory tract infection than as secondary to pulmonary infection. The nasopharynx may be a portal of entry for tubercle bacilli in patients who develop cervical lymphadenitis. Involvement of the nasopharynx by TB may be underdiagnosed because it does not produce obvious symptoms or physical signs in all cases.     

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.     

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.     

Tuberculous mastoiditis.

The prevalence of Mycobacterium tuberculosis is increasing due in part to the rising incidence of immunocompromised hosts. Although Mycobacterium tuberculosis is a well-documented pathogen in otitis media and mastoiditis, its extremely low incidence often precludes consideration when treating these infections. This is especially true when concomitant pulmonary symptoms are absent. We describe two patients who initially presented after prolonged unsuccessful medical and surgical therapy for chronic mastoiditis. In both, the diagnosis of Mycobacterium tuberculosis mastoiditis was made after the onset of complete facial paralysis. On subsequent investigations, one had an asymptomatic pulmonary focus while the other was felt to have primary mastoid disease. Both patients had normal immunological profiles. This report underscores the importance of considering a tuberculous infection in all cases of otitis media and mastoiditis which do not initially respond to conventional antibacterial therapy. This holds true in both immunocompromised and immunocompetent hosts. Early diagnosis with prompt institution of antituberculous therapy is essential to avoid facial nerve paralysis and other grave complications.