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Misirovs R, Johnston L, Green R. Primary nasopharyngeal tuberculosis. BMJ Case Rep 2022; 15:e251927. [PMID: 36593611 PMCID: PMC9730391 DOI: 10.1136/bcr-2022-251927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
No part of the human body is immune to tuberculosis, the most common site being the lungs. We report a rare case of primary nasopharyngeal tuberculosis without cervical lymphadenopathy nor pulmonary involvement. The only presenting symptom was an intermittent discomfort in the neck and throat. Several biopsies were performed to exclude nasopharyngeal carcinoma and to reach the final diagnosis of tuberculosis. The patient made full recovery following 6 months of treatment with antibiotics. A multidisciplinary approach by ear, nose and throat, radiology, pathology, and infectious disease colleagues was crucial in reaching the diagnosis and managing the patient.
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Affiliation(s)
- Rasads Misirovs
- Scottish Centre for Respiratory Research, University of Dundee, Dundee, UK
- Doctoral studies, Riga Stradins University, Riga, Latvia
| | - Lisa Johnston
- Department of Histopathology, Ninewells Hospital and Medical School, Dundee, UK
| | - Richard Green
- Department of Otorhinolaryngology, Ninewells Hospital and Medical School, Dundee, UK
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Oon A, Razuan NA, Kuppan G, Mahadzir M. Nasopharyngeal Tuberculosis mimicking Nasopharyngeal Carcinoma: A Case Series. Indian J Otolaryngol Head Neck Surg 2022; 74:1612-1614. [PMID: 36452685 PMCID: PMC9702232 DOI: 10.1007/s12070-021-02770-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/18/2021] [Indexed: 11/26/2022] Open
Abstract
Tuberculosis is a highly contagious granulomatous disease which is endemic in South East Asia. Most common presentation is pulmonary tuberculosis which is spread by droplets inhalation of mycobacterium tuberculosis bacterium. Nasopharyngeal tuberculosis is a rare entity which poses a diagnostic difficulty as its presentation is greatly similar to that of nasopharyngeal carcinoma. Herein, we describe two cases of nasopharyngeal tuberculosis which mimics nasopharyngeal malignancy leading to diagnostic difficulties.
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Affiliation(s)
- Amy Oon
- Department of Otorhinolaryngology, University Malaya Medical Centre, 46200 Kuala Lumpur, Malaysia
| | - Nur Aida Razuan
- Department of Otorhinolaryngology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Ganesan Kuppan
- Department of Otorhinolaryngology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Mazlinda Mahadzir
- Department of Otorhinolaryngology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
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Vergara-de la Rosa E, Galvez-Olortegui J, Galvez-Olortegui T, Concepcion-Urteaga L. Is the Nasal Airway the Main Mode of Transmission for Pharyngeal Tuberculosis? ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017. [DOI: 10.1016/j.otoeng.2016.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vergara-de la Rosa E, Galvez-Olortegui J, Galvez-Olortegui T, Concepcion-Urteaga L. Is the nasal airway the main mode of transmission for pharyngeal tuberculosis? ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016; 68:66-67. [PMID: 27776805 DOI: 10.1016/j.otorri.2016.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 07/11/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Esteban Vergara-de la Rosa
- Scientia Clinical and Epidemiological Research Institute, Trujillo, Perú; Servicio de Otorrinolaringología, Hospital Regional Docente de Trujillo, Trujillo, Perú; Escuela de Posgrado, Universidad Privada Antenor Orrego, Trujillo, Perú.
| | - José Galvez-Olortegui
- Scientia Clinical and Epidemiological Research Institute, Trujillo, Perú; Facultad de Medicina, Universidad Nacional de Trujillo, Trujillo, Perú
| | - Tomas Galvez-Olortegui
- Scientia Clinical and Epidemiological Research Institute, Trujillo, Perú; Escuela de Posgrado, Universidad Privada Antenor Orrego, Trujillo, Perú
| | - Luis Concepcion-Urteaga
- Facultad de Medicina, Universidad Nacional de Trujillo, Trujillo, Perú; Servicio de Neumología, Hospital Regional Docente de Trujillo, Trujillo, Perú
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Nasopharyngeal Tuberculosis: Epidemiology, Mechanism of Infection, Clinical Manifestations, and Management. Int J Otolaryngol 2016; 2016:4817429. [PMID: 27034677 PMCID: PMC4789561 DOI: 10.1155/2016/4817429] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 02/10/2016] [Accepted: 02/11/2016] [Indexed: 12/30/2022] Open
Abstract
Nasopharyngeal tuberculosis (NPTB) is a noteworthy disease especially in its worldwide spread of the Mycobacterium infection. Although NPTB has been identified in less than one percent of TB cases, recent multiple case reports indicate an either increased awareness or incidence of this disease. The most helpful diagnostic tool is an uncomplicated nasopharyngeal biopsy. However, NPTB is usually ignored because it has varied clinical manifestations and similar presentations with other more common head and neck diseases. Furthermore, the most common presenting symptom is cervical lymphadenopathy mimicking nasopharyngeal carcinoma, a more common and serious disease. Treatment outcomes of NPTB are good in both HIV-positive or HIV-negative patients. In addition, pulmonary tuberculosis association was reported in wide range between 8.3% and 82% which should be considered in a treatment program. In conclusion, early diagnosis and management in NPTB can be achieved by (1) increased awareness of this disease, (2) improvement in knowledge regarding clinical manifestations, and (3) improvement of diagnostic techniques.
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Oh SJ, Yi KI, Lee CH, Cho KS. Primary tuberculosis of the eustachian tube causing otitis media with effusion. Am J Otolaryngol 2015; 36:575-7. [PMID: 25935077 DOI: 10.1016/j.amjoto.2015.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 04/05/2015] [Indexed: 10/23/2022]
Abstract
Eustachian tube (ET) dysfunction may cause pathological changes in the middle ear, including recurrent acute otitis media and otitis media with effusion (OME). Mechanical obstruction of the ET may be caused by primary tumor-like lesions arising from ET or secondary ET infiltration due to nasopharyngeal and parapharyngeal space tumor. Tuberculosis is known to affect almost every organ in the body, and it should be a concern of each and every medical practitioner. However, tuberculosis of the ET has not been reported in the literature previously. This article reports primary tuberculosis arising in the ET that presented as aural fullness and hearing disturbance in a patient with OME.
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Cai PQ, Li YZ, Zeng RF, Xu JH, Xie CM, Wu YP, Wu PH. Nasopharyngeal tuberculosis: CT and MRI findings in thirty-six patients. Eur J Radiol 2013; 82:e448-54. [PMID: 23689055 DOI: 10.1016/j.ejrad.2013.04.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 03/03/2013] [Accepted: 04/02/2013] [Indexed: 12/13/2022]
Abstract
PURPOSE Tuberculosis is uncommon in the nasopharynx. The purpose of this study was to investigate the CT and MRI features of 36 cases of tuberculosis in this area. MATERIALS AND METHODS CT (n=15) and MRI (n=21) scans from 36 patients with histologically proved tuberculosis of the nasopharynx were reviewed by two experienced radiologists, paying particular attention to the lesions' distribution, location, extent, size, internal architecture, pattern, and degree of enhancement, and cervical lymphadenopathy. RESULTS Twenty-nine patients exhibited a polypoid mass pattern and seven had diffuse mucosal thickening. The roof of the nasopharynx was involved in all cases. The mean size of the lesions was 11.4mm. Striped pattern was detected in 19 cases. Adjacent muscle invasion or bone destruction was not detected. Heterogeneous enhancement was detected in all patients, and necrosis in the nasopharyngeal lesions was detected in 16 cases. Poor, moderate, and marked enhancement was detected in one, 27, and eight cases, respectively. Thirty-four patients had involvement of the cervical lymph nodes. Twenty-two and 28 cases were associated with bilateral lymphadenopathy or necrosis, respectively. The retropharyngeal lymph node was the most commonly involved site (94.1%). CONCLUSION The presence of necrosis and striped pattern in nasopharyngeal lesions, site predilection, no invasion of regional structures, and central necrosis with peripheral rim enhancement of cervical lymphadenopathy may suggest the diagnosis of nasopharyngeal tuberculosis.
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Affiliation(s)
- Pei-Qiang Cai
- Department of Radiology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, 651 Dongfengdong Road, Guangzhou 510060, China.
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Abstract
Today, the opportunity to see tuberculosis is decreasing. Nasopharyngeal tuberculosis is a rare entity, even in endemic tuberculosis areas. A case of nasopharyngeal tuberculosis is described. A 28-year-old woman presented with a sore throat. Irregular mucosal thickening was seen in the nasopharynx. Staining for acid-fast bacilli was positive (Gaffky 1), and the PCR test was positive for Mycobacterium tuberculosis from pharyngeal mucus. Computed tomography showed mucosal thickening in the pharynx and old pulmonary tuberculosis in the right upper lobe. Multiple anti-tuberculosis drug therapy was performed for 6 months. A few days after the initiation of therapy, the pharyngeal pain subsided. The irregular mucosal thickening was quite thin after 1 month of multidrug therapy and was no longer observed after 2 months. A case of nasopharyngeal tuberculosis is reported. A good result was obtained with multiple anti-tuberculous drug therapy for 6 months. Nasopharyngeal tuberculosis should be considered in the differential diagnosis of a white nasopharyngeal coating, especially in a patient with a history of pulmonary tuberculosis.
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Ziad T, Nouri H, Adny A, Rochdi Y, Aderdour L, Raji A. [Acute miliary tuberculosis or Isambert disease: a case report]. Arch Pediatr 2012; 20:41-3. [PMID: 23266174 DOI: 10.1016/j.arcped.2012.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 09/02/2012] [Accepted: 10/15/2012] [Indexed: 11/30/2022]
Abstract
Pharynx tuberculosis consists in a set of active lesions in granulomatous-type mucosa, resulting from Mycobacterium tuberculosis infection. In an endemic context, this diagnosis should be raised in cases of head and neck disease. A recent observation of a case of acute miliary tuberculosis gave us the opportunity to conduct a literature review of this disorder. This 9-year-old girl presented with dysphagia associated with pharyngeal discomfort, snoring, and hoarseness lasting for 8 months. This pharyngeal syndrome occurred in the context of an impaired general condition. Clinical examination found a diffuse mucosal granulation aspect in the oropharynx. The workup showed an inflammatory syndrome with a strong positive intradermal tuberculin reaction. The biopsy found an aspect of giant cell granuloma with caseous necrosis. The course was favorable on antituberculous chemotherapy. Tuberculosis is a chronic bacterial infection caused by a bacterium belonging to the M. tuberculosis complex. Pharyngeal tuberculosis remains a rare disease, but several epidemiological parameters show an upsurge of this disease, prompting us to report this observation.
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Affiliation(s)
- T Ziad
- Service d'ORL et chirurgie cervico-faciale, CHU Mohammed VI, Marrakech, Maroc.
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Primary nasopharyngeal tuberculosis mimicking exacerbation of chronic rhinosinusitis. The Journal of Laryngology & Otology 2011; 125:747-9. [PMID: 21481293 DOI: 10.1017/s0022215110002835] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Nasopharyngeal tuberculosis is a rare condition, even in endemic tuberculosis areas. We report a case of primary nasopharyngeal tuberculosis from a non-endemic area, which presented with symptoms resembling exacerbation of previously diagnosed chronic rhinosinusitis. CASE REPORT A 48-year-old man presented with extreme postnasal drip and an unpleasant nasal odour. Endoscopic examination revealed irregular thickening of the left lateral and posterior wall of the nasopharynx, partially covered with crusts and necrotic tissue. Histopathological study showed typical giant cell epithelioid granulomas with caseous necrosis. Direct examination after Ziehl-Neelsen staining was positive for tuberculosis. After six months of antituberculous triple therapy, endoscopic examination revealed a completely normal nasopharynx. CONCLUSION To our best knowledge, this is the first published report of primary nasopharyngeal tuberculosis in a patient previously diagnosed with chronic rhinosinusitis. The difficulties in obtaining a proper diagnosis in such a case are discussed.
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Kharoubi S. [Pharyngeal tuberculosis]. ACTA ACUST UNITED AC 2008; 125:218-23. [PMID: 18561894 DOI: 10.1016/j.aorl.2008.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Accepted: 04/08/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this case study was to report a rare case of acute miliary tuberculosis of the pharynx. The description of the various pathological forms of this disease and a review of the literature are included. METHODS Report of a case of acute miliary tuberculosis of the pharynx in a 20-year-old female patient with chronic dysphagia and weight loss. RESULTS Dysphagia with epistaxis and severe nutritional problems was noted. The pharyngeal examination showed diffuse granulation of the pharynx. The blood count showed an inflammatory syndrome. The tuberculin skin test was highly positive. A pharyngeal biopsy found caseous necrosis in giant cell granuloma. The prognosis was good with antituberculosis antibiotics. CONCLUSION Acute miliary tuberculosis of the pharynx is a rare entity. Many epidemiological studies have shown an increased frequency of this disease, which should therefore be kept mind.
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Affiliation(s)
- S Kharoubi
- Faculté de médecine, route de Zaâfrania, B.P. 205, 23000 Annaba, Algeria.
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King AD, Ahuja AT, Leung SF, Abrigo J, Wong JKT, Poon WS, Woo KS, Chan HS, Tse GMK. MR imaging of nonmalignant polyps and masses of the nasopharynx and sphenoid sinus after radiotherapy for nasopharyngeal carcinoma. AJNR Am J Neuroradiol 2008; 29:1209-14. [PMID: 18467517 DOI: 10.3174/ajnr.a1043] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The development of a new polyp or mass in the radiation field of a previously treated carcinoma is usually an ominous sign of a recurrent cancer, but rarely may it be caused instead by a nonmalignant process. The purpose of this study was to document the MR appearance of unusual nonmalignant polyps or masses (NMPMs) in the nasopharynx and sphenoid sinus arising after radiation treatment of nasopharyngeal carcinoma. MATERIALS AND METHODS The MR imaging reports of patients undergoing imaging after radiation therapy for nasopharyngeal carcinoma were reviewed retrospectively to identify patients with unusual polyps and masses in the nasopharynx. The MR images of those patients with no evidence of malignancy on biopsy or follow-up were reviewed. RESULTS The MR imaging reports of 1282 patients were reviewed, and 11 patients (1%) with NMPMs in the nasopharynx or sphenoid sinus were identified. Two patterns were identified: contrast enhancing nasopharyngeal polyps ranging in size from 1 to 5 cm (n = 5) and sphenoid sinus masses consisting of a nonenhancing mass filling a nonexpanded sinus (n = 4) and a heterogeneous enhancing mass expanding the sinus (n = 2). Osteoradionecrosis produced a large defect in the roof of the nasopharynx causing direct communication with the sphenoid sinus (n = 6). Histology revealed granulation tissue in all of the patients with variable amounts of fibrin and inflammatory cells. A direct infective etiology was not proved in any patient. CONCLUSION NMPMs in the nasopharynx and sphenoid sinus are rare complications after radiation therapy to the skull base, but the radiologist needs to be aware of their appearance so that they can be considered in the differential diagnosis of suspected tumor recurrence.
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Affiliation(s)
- A D King
- Department of Diagnostic Radiology and Organ Imaging, Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China.
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Oktem F, Güvenç MG, Yilmaz S, Edizer DT, Kara B. Asymptomatic retropharyngeal abscess related to cervical Pott's disease. Am J Otolaryngol 2006; 27:278-80. [PMID: 16798409 DOI: 10.1016/j.amjoto.2005.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Pott's disease is an uncommon manifestation of tuberculosis, which usually involves thoracic or lumbar vertebrae. The body of the vertebrae is most severely affected and a compression fracture is an almost inevitable consequence of the disease. A paravertabral abscess generally accompanies vertebral involvement. Tenderness over the involved vertebrae, weakness of the related muscles, and paraesthesia are the usual symptoms. In this article, we report a case of cervical Pott's disease presenting mainly with neurologic symptoms such as weakness, pain, numbness of both arms and hands, and an asymptomatic retropharyngeal abscess.
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Affiliation(s)
- Fatih Oktem
- Department of Otorhinolaryngology, Istanbul University, Cerrahpaşa Medical Faculty, Turkey
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Srirompotong S, Yimtae K, Jintakanon D. Nasopharyngeal tuberculosis: manifestations between 1991 and 2000. Otolaryngol Head Neck Surg 2005; 131:762-4. [PMID: 15523462 DOI: 10.1016/j.otohns.2004.02.052] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES/HYPOTHESIS To present the clinical manifestation of nasopharyngeal tuberculosis. STUDY DESIGN Clinical analysis of 23 patients with pathologically confirmed nasopharyngeal tuberculosis was carried out retrospectively. SETTING Srinagarind Hospital, Khon Kaen University. Thailand. RESULTS The most common presenting symptom was cervical lymphadenopathy (91.3%). The common locations of nodes were the superior and middle cervical. The abnormalities of the nasopharynx were found in 16 patients. The pathological findings were caseous granuloma with positive acid-fast bacilli (AFB) in 15 cases, caseous granuloma with negative AFB in 3 cases, and chronic granulomatous inflammation with negative AFB in 5 cases. Pulmonary tuberculosis was found in 8 of 18 patients. Sixteen patients who received complete treatment responded well. CONCLUSION Nasopharyngeal tuberculosis commonly presents with cervical lymphadenopathy. The differential diagnosis of tuberculosis from nasopharyngeal carcinoma is difficult. In the patients who have cervical lymphadenopathy and no other identified causes, biopsy of nasopharynx would give an additive information for diagnosis.
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Affiliation(s)
- Somchai Srirompotong
- Department of Otolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
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Kharoubi S. [Acute miliary tuberculosis of the pharynx. A case report]. REVUE DE PNEUMOLOGIE CLINIQUE 2004; 60:296-298. [PMID: 15687916 DOI: 10.1016/s0761-8417(04)72118-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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Tse GMK, Ma TKF, Chan ABW, Ho FNY, King AD, Fung KSC, Ahuja AT. Tuberculosis of the nasopharynx: a rare entity revisited. Laryngoscope 2003; 113:737-40. [PMID: 12671437 DOI: 10.1097/00005537-200304000-00027] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Tuberculosis of the nasopharynx is uncommon. A large series of 17 cases is reported, and the clinical and pathological features are discussed. STUDY DESIGN A retrospective review. METHODS Seventeen archived cases of biopsy-proven nasopharyngeal tuberculosis were reviewed for patient age and sex, presenting complaint and duration, systemic symptoms, cervical lymphadenopathy, and chest x-ray findings. These findings were compared with a compilation of 40 cases reported in the English literature. RESULTS There was a female predominance (13 women and 4 men), with age range of 20 to 74 years (mean age, 38 y). The most common presentation was enlargement of the cervical lymph nodes (53%), followed by hearing loss (12%), tinnitus, otalgia, nasal obstruction, and postnasal drip (6% each). The duration of the presenting symptoms ranged from 1 week to 1 year (mean duration, 16 wk). Ten patients (59%) had cervical lymphadenopathy, two (12%) had systemic symptoms (fever, weight loss, night sweats), and one patient (6%) had miliary pulmonary tuberculosis. Direct endoscopic examination showed nasopharyngeal mucosal irregularity or mass in the majority of patients (12 patients [70%]). These features were similar to those reported in the literature. CONCLUSIONS Nasopharyngeal tuberculosis is uncommon, usually occurring without pulmonary or systemic involvement. Cervical lymphadenopathy occurs in more than half of the patients and is the most common presenting complaint; this, together with the nasopharyngeal findings of mass or mucosal irregularity, makes differentiation from carcinoma on clinical examination difficult, necessitating histological evaluation.
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Affiliation(s)
- Gary M K Tse
- Department of Anatomical and Cellular Pathology, Division of Otorhinolaryngology, Prince of Wales Hospital, Chinese University of Hong Kong, Republic of China.
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Abstract
Isolated nasopharyngeal tuberculosis is a rare disease. It has been reported as cases in recent years. An incidentally found case without any nasal or otological symptoms is presented.
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Affiliation(s)
- A Köktener
- EMERAY Imaging Center, Ziya Bey Cad. No: 26/1, Balgat, Ankara, Turkey.
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