Diagnostic dilemma in a patient with nasopharyngeal tuberculosis: A case report and literature review

Abstract

Tuberculosis remains a major cause of morbidity and mortality globally, with a global total of about 10 million people falling ill with it in 2020. Until the coronavirus (COVID-19) pandemic, tuberculosis was the leading cause of death from a single infectious agent. Nasopharyngeal tuberculosis is a rare type of extrapulmonary tuberculosis that may be either primary or secondary to pulmonary tuberculosis. Nasopharyngeal tuberculosis may be mistaken for nasopharyngeal carcinoma as both conditions may present with a nasopharyngeal mass and cervical lymph node enlargement. We present a case of nasopharyngeal tuberculosis secondary to pulmonary tuberculosis who presented without any nasal or respiratory symptoms. The patient presented with a cervical lymph node enlargement and a nasopharyngeal mass was detected on nasal endoscopy. Fine needle cytology from the cervical node and the initial biopsy report from the nasopharyngeal mass were not confirmatory, causing a diagnostic dilemma. A repeat biopsy from the nasopharyngeal mass with the demonstration of caseating granuloma and acid-fast bacilli in the specimen pointed to the diagnosis of nasopharyngeal tuberculosis. The patient responded well to the standard 6-month anti-tubercular regimen. Nasopharyngeal tuberculosis may mimic nasopharyngeal carcinoma and a repeat biopsy may be necessary to confirm the diagnosis.

CT and MRI presentation of nasopharyngeal tuberculosis (with a case report)

“…Nasopharyngeal tuberculosis is a rare form of extrapulmonary tuberculosis caused by M tuberculosis invading the nasopharynx. Patients often have symptoms such as enlarged cervical lymph nodes, nasal congestion, runny nose, blood in the mucus, stuffy ears, and hearing loss [6] , [7] , [8] , [9] . Besides, they may have sore throats and sleep snoring [ 10 , 11 ], and a few patients may have systemic symptoms such as low-grade fever, night sweats, and fatigue.…”

Granulomatoses Nasais: relatos de casos e revisão de literatura direcionada diagnóstico

“…A tuberculose de localização nasal é extremamente incomum, representando apenas 0,1% dos casos e sendo em sua grande maioria (75%) secundária a uma evolução da tuberculose pulmonar [6][7][8][9][10][11][12] . O diagnóstico pode ser feito através de achados histopatológicos e microbiológicos a partir de uma biópsia 6,10,11,13,14 . O achado histopatológico patognomônico é a presença de infiltrado inflamatório granulomatoso juntamente com células gigantes de Langhans e necrose caseosa 6,[10][11][12][13][14] .…”

“…O diagnóstico pode ser feito através de achados histopatológicos e microbiológicos a partir de uma biópsia 6,10,11,13,14 . O achado histopatológico patognomônico é a presença de infiltrado inflamatório granulomatoso juntamente com células gigantes de Langhans e necrose caseosa 6,[10][11][12][13][14] . Tanto o isolamento de bacilos ácido-resistentes quanto a cultura de M. tuberculosis podem ser encontrados, porém são de alta dificuldade 12,13 .…”