Primary Nasopharyngeal Tuberculosis: A Diagnostic Challenge

Document Type : Case Report

Authors

1 Department of Otorhinolaryngology - Head & Neck Surgery, School of Medical Sciences, University Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia.

2 Department of Otorhinolaryngology - Head & Neck Surgery, Pantai Hospital Sungai Petani, 08000 Sungai Petani, Kedah, Malaysia.

3 Department of Pathology, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43000 Serdang, Selangor, Malaysia.

Abstract

Introduction:
Primary nasopharyngeal tuberculosis (NPTB) is a rare disease but should not be missed as one of the differential diagnoses for cervical lymphadenopathy or nasopharyngeal mass. 
Case Report:
We describe a case of a 38 year old lady, who presented with bilateral cervical lymphadenopathy associated with intermittent fever. Nasoendoscopy examination and computed tomography scan of the neck revealed a centrally located mass predominantly at the left posterior nasopharyngeal wall without obliteration of both fossae of Rosenmuller. Typical histopathological features of necrotizing granulomatous lymphadenitis together with the common clinical presentation of cervical lymphadenopathy and nasoendoscopy findings of nasopharyngeal mass conclude the diagnosis of nasopharyngeal tuberculosis. With anti-tuberculous therapy, the cervical lymphadenopathy and nasopharyngeal mass were completely resolved.
Conclusion:
Nasopharyngeal tuberculosis is an uncommon disease with great diagnostic challenges and with early diagnosis and adequate treatment, NPTB carries a good prognosis with complete disease resolution.

Keywords

Main Subjects

References

  1. World Health Organization (WHO). WHO report on TB 2020. Vol. 1, Who. 2020. 232 p.
  2. Menon K, Bem C, Gouldesbrough D, Strachan DR. A clinical review of 128 cases of head and neck tuberculosis presenting over a 10-year period in Bradford, UK. J Laryngol Otol. 2007 Apr 21; 121(4): 362–8.
  3. Cai P, Li Y, Zeng R, Xu J, Xie C, Wu Y, et al. Nasopharyngeal tuberculosis: CT and MRI findings in thirty-six patients. Eur J Radiol . 2013 Sep; 82(9): e448–54.
  4. Srirompotong S, Yimtae K, Jintakanon D. Nasopharyngeal Tuberculosis: Manifestations between 1991 and 2000. Otolaryngol Neck Surg. 2004 Nov 17;131(5):762–4.
  5. Tse GMK, Ma TKF, Chan ABW, Ho FNY, King AD, Fung KSC, et al. Tuberculosis of the Nasopharynx: A Rare Entity Revisited. Laryngoscope. 2003 Apr;113(4):737–40.
  6. Aktan B, SelimoĞlu E, Üçüncü H, Sütbeyaz Y. Primary nasopharyngeal tuberculosis in a patient with the complaint of snoring. J Laryngol Otol. 2002 Apr 8;116(4):301–3.
  7. Yildirim N, Şahan M, Karslioğlu Y. Adenoid Hypertrophy in Adults: Clinical and Morphological Characteristics. J Int Med Res. 2008 Jan 1; 36(1): 157–62.
  8. AD K, AT A, GM T, AC van H, AB C. MR imaging features of nasopharyngeal tuberculosis: report of three cases and literature review. AJNR Am J Neuroradiol. 2003 Feb;24(2):279–82.
  9. Mitra B, Sengupta S, Rai A, Mehta J, Quader AR, Roy S, et al. Chordoma in Nasopharynx in a 70-Year-Old Female: A Rare Occurence. Int J Otolaryngol Head Neck Surg. 2014;3:342–6.
  10. Multidrug–Resistant Human Mycobacterium tuberculosis Strain Resisted Inactivation by 10% Formalin. 2012;1.
  11. Tachibana T, Ogawara Y, Matsuyama Y, Abe I, Orita Y, Nishizaki K, et al. Factors that make it difficult to diagnose cervical tuberculous lymphadenitis. J Infect Chemother. 2013; 19(6): 1015–20.
  12. Goel MM, Budhwar P. Immunohistochemical localization of mycobacterium tuberculosis complex antigen with antibody to 38 kDa antigen versus Ziehl Neelsen staining in tissue granulomas of extrapulmonary tuberculosis. Indian J Tuberc. 2007 Jan; 54(1):24–9.
  13. Sarmiento OL, Weigle KA, Alexander J, Weber DJ, Miller WC. Assessment by Meta-Analysis of PCR for Diagnosis of Smear-Negative Pulmonary Tuberculosis. J Clin Microbiol. 2003 Jul; 41(7): 3233–40.

 

 

 

 

 

Iranian Journal of Otorhinolaryngology
Volume 35, Issue 1
January and February 2023
Pages 61-66

Files

Share

How to cite

Statistics