1
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Ngo Pambe CJ, Onana Y, Essame Oyono JL, Ongolo Zogo P, Mendimi JM. [Primary tuberculosis of the cavum: An unusual diagnosis]. Ann Pathol 2023; 43:483-486. [PMID: 36948994 DOI: 10.1016/j.annpat.2023.03.001] [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] [Received: 12/24/2022] [Revised: 02/13/2023] [Accepted: 03/02/2023] [Indexed: 03/24/2023]
Abstract
Primary tuberculosis of the cavum is a rare entity. It can occur at any age, especially between the second and ninth decade. We report the case of a 17-years-old patient with nasal obstruction and left laterocervical adenomegaly. A cervico-facial CT scan showed a suspicious looking tumor process of the nasopharynx. Histological analysis of the biopsies taken showed chronic granulomatous inflammation with necrosis and the absence of tuberculosis lesions in the usual sites, especially the lungs, led to the diagnosis of primary tuberculosis of the cavum. There was a good evolution on antituberculosis drugs. This unusual location can be a source of difficulties and delay in diagnosis, especially because of the clinical presentation, which suggests a nasopharyngeal tumour. In developing countries, where this disease remains relatively endemic, cross-sectional imaging techniques and histopathological analysis are of great interest for the management of patients.
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Affiliation(s)
- Christiane Judith Ngo Pambe
- Département des sciences morphologiques et d'anatomie pathologique, faculté de médecine et des sciences biomédicales, université de Garoua, 317 Garoua, Cameroun.
| | - Yannick Onana
- Département de radiologie et d'imagerie médicale, faculté de médecine et des sciences biomédicales, université de Garoua, 317 Garoua, Cameroun
| | - Jean-Louis Essame Oyono
- Département des sciences morphologiques et d'anatomie pathologique, faculté de médecine et des Sciences biomédicales, université de Yaoundé I, 1634 Yaoundé, Cameroun
| | - Pierre Ongolo Zogo
- Département de radiologie et d'imagerie médicale, faculté de médecine et des sciences biomédicales, université de Yaoundé I, 1634 Yaoundé, Cameroun
| | - Joseph Marie Mendimi
- Département des sciences morphologiques et d'anatomie pathologique, faculté de médecine et des Sciences biomédicales, université de Yaoundé I, 1634 Yaoundé, Cameroun
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2
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Kim M, Lee JH, Lee HN, Park DJ, Lee EJ. Nasopharyngeal Tuberculosis with Concomitant Middle Ear Tuberculosis: A Case Report and Literature Review. EAR, NOSE & THROAT JOURNAL 2022:1455613221103087. [PMID: 35599612 DOI: 10.1177/01455613221103087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Tuberculosis (TB), an infectious disease caused by Mycobacterium tuberculosis (MTB), can affect the lungs (pulmonary TB) as well as other sites (extrapulmonary TB). Nasopharyngeal tuberculosis (NPTB) is a rare type of extrapulmonary TB. Since NPTB has nonspecific clinical presentation with low index of suspicion, it is difficult for clinicians to make an early diagnosis and proper treatment. We recently encountered a 42-year-old woman with NPTB concomitant with middle ear TB, which strongly mimicked nasopharyngeal carcinoma. Since the diagnosis of NPTB was difficult to confirm based on endoscopic findings and imaging studies, this patient underwent nasopharyngeal biopsy, and finally, polymerase chain reaction (PCR) confirmed NPTB. This report describes our NPTB case as well as summarizes all cases of NPTB reported in South Korea. We highlight that active tissue biopsy with antibacterial smear and additional PCR or specific TB blood test should be considered for cases with high suspicion of NPTB.
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Affiliation(s)
- Minheon Kim
- Department of Otorhinolaryngology, 37974Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Joo Hyung Lee
- Department of Otorhinolaryngology, 37974Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Ha Neul Lee
- Department of Otorhinolaryngology, 37974Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Dong-Joon Park
- Department of Otorhinolaryngology, 37974Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Eun Jung Lee
- Department of Otorhinolaryngology, 37974Yonsei University Wonju College of Medicine, Wonju, South Korea
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3
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Li TY, Lo WC, Cheng PW. Nasopharyngeal mass resulting in bilateral otitis media with effusion. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 139:236-238. [PMID: 34565699 DOI: 10.1016/j.anorl.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/23/2021] [Accepted: 07/01/2021] [Indexed: 11/03/2022]
Affiliation(s)
- T-Y Li
- Department of Otolaryngology, Far Eastern Memorial Hospital, 21, Section 2, Nan-Ya South Road, Pan Chiao, Taipei 220, Taiwan
| | - W-C Lo
- Department of Otolaryngology, Far Eastern Memorial Hospital, 21, Section 2, Nan-Ya South Road, Pan Chiao, Taipei 220, Taiwan
| | - P-W Cheng
- Department of Otolaryngology, Far Eastern Memorial Hospital, 21, Section 2, Nan-Ya South Road, Pan Chiao, Taipei 220, Taiwan.
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4
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Min HJ, Kim KS. Primary Nasopharyngeal Tuberculosis: A Case Report Focused on Nasopharyngoscopic Features and CT Findings. EAR, NOSE & THROAT JOURNAL 2020; 100:949S-952S. [PMID: 32511010 DOI: 10.1177/0145561320931951] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Primary nasopharyngeal tuberculosis, defined as an isolated tuberculosis infection of the nasopharynx without systemic or pulmonary disease, is rare, even in areas endemic for tuberculosis. It is challenging for ENT specialists to diagnose primary nasopharyngeal tuberculosis at an early stage. In this report, we describe a new case of primary nasopharyngeal tuberculosis, focusing on its nasopharyngoscopic features and radiological findings that can help the understanding and aid in accurate diagnosis of this unusual disease entity. Our experience suggests that although primary nasopharyngeal tuberculosis is a relatively rare disease, it must be included in the differential diagnosis of various nasopharyngeal lesions, particularly in patients with unusual nasopharyngoscopic and computed tomography findings.
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Affiliation(s)
- Hyun Jin Min
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Dongjak-gu, Seoul, Korea
| | - Kyung Soo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Dongjak-gu, Seoul, Korea
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5
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Abstract
Upper respiratory tract involvement in cases of tuberculosis (TB) of the head and neck continues to be described in the most recent reports from several different regions, including some from developed countries. Laryngeal TB is the most common of all forms of upper respiratory tract TB (URT-TB). Pulmonary lesions in URT-TB are present in about 20% of adults and about 50 to 60% of children. Systemic manifestations are uncommon. URT-TB is especially seen in patients with a variety of risk factors, such as the presence of human immunodeficiency virus (HIV) infection, diabetes, smoking, alcoholism, drug abuse, malignancies, and use of immunosuppressive drugs. Nodules or ulcerative lesions are seen on morphological examination. Endoscopic examination is required for mucosal lesions. Diagnosis of TB is suspected on an epidemiological basis in high-prevalence countries or from the failure of a patient to respond to routine treatment. Smear and/or histopathological examinations help in establishing the final etiological diagnosis. Treatment includes standard anti-TB chemotherapy for at least 6 months with four primary drugs during the initial intensive phase of 2 months and two or three primary drugs during the remaining maintenance phase of 4 months. Treatment is modified on the basis of culture and sensitivity reports in cases of suspected drug resistance. Surgical intervention may be required for some patients with abscess formation and progressive disease unresponsive to medical therapy. Airway obstruction, although rare, even in fulminant cases may require tracheostomy for relief.
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6
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Thakur JS, Verma N, Mohindroo S, Azad RK, Mohindroo NK. Isolated tubercular hypoglossal nerve paralysis. Trop Doct 2016; 47:255-260. [DOI: 10.1177/0049475516649894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hypoglossal nerve palsy is not an uncommon neurological finding but primary nasopharyngeal tuberculosis (TB) presenting as hypoglossal nerve palsy is very rare. A 31-year-old woman presented with headache and progressive tongue deviation towards the right side. Diagnostic nasal endoscopy revealed soft tissue mass lesion on the posterior wall of nasopharynx while MRI revealed isointense tumour in nasopharynx with normal hypoglossal nerve and brain. Histopathological examination found TB. We discuss the clinical challenges and possible pathogenesis of this rare clinical entity.
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Affiliation(s)
- JS Thakur
- Department of Otolaryngology-Head and Neck Surgery (ENT), Indira Gandhi Medical College, Shimla, HP, India
| | - Naina Verma
- Department of Otolaryngology-Head and Neck Surgery (ENT), Indira Gandhi Medical College, Shimla, HP, India
| | - Shobha Mohindroo
- Department of Pathology, Indira Gandhi Medical College, Shimla, HP, India
| | - Ramesh K Azad
- Department of Otolaryngology-Head and Neck Surgery (ENT), Indira Gandhi Medical College, Shimla, HP, India
| | - NK Mohindroo
- Department of Otolaryngology-Head and Neck Surgery (ENT), Indira Gandhi Medical College, Shimla, HP, India
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7
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Nakao Y, Shibata R, Murohara T, Tanigawa T. Primary nasopharyngeal tuberculosis: a case report. BMC Infect Dis 2016; 16:121. [PMID: 26980081 PMCID: PMC4793499 DOI: 10.1186/s12879-016-1449-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 03/01/2016] [Indexed: 11/12/2022] Open
Abstract
Background The occurrence of nasopharyngeal tuberculosis is rare even in areas where tuberculosis is endemic. Here, we report a case of rare primary nasopharyngeal tuberculosis, promptly evaluated by nasolaryngoscopy. Case presentation A 78-year-old woman presented with postnasal drip and a cough of 1-month duration. Endoscopic examination of the nasopharynx revealed irregular mucosal thickening of the right lateral and posterior wall of the naso (epi)-pharynx, which was covered with yellow discharge presenting as postnasal drip. Computed tomography (CT) demonstrated enhanced soft tissue area in the right lateral and posterior wall of the nasopharynx. Bacteriological examination from a nasopharyngeal swab revealed that staining for acid-fast bacilli was positive and the quenching probe PCR test was positive for Mycobacterium tuberculosis. Histopathological examination from the thickening nasopharyngeal mucosa revealed granulomatous formation with caseous necrosis. Ziehl-Nielsen staining directly could detect acid-fast bacilli. Chest X-ray and CT scan ruled out the pulmonary tuberculosis. Base on these findings, we diagnosed it as primary nasopharyngeal tuberculosis. After six months anti-tuberculous therapy, the patient’s symptoms had completely disappeared. Nasolaryngoscopic examination and CT image after 6 months post therapy revealed a normal nasopharynx with complete resolution of the lesion. Conclusion We recommend endoscopic examination for patients suffering from chronic postnasal drips to avoid inappropriate diagnosis.
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Affiliation(s)
- Yoshio Nakao
- Department of Otolaryngology, Yoshida General Hospital, Hiroshima, Japan
| | - Rei Shibata
- Department of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan. .,Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tohru Tanigawa
- Department of Otorhinolaryngology, Aichi Medical University, Nagakute, Aichi, 480-1195, Japan.
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8
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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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9
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Mishra RK, Prasad BK, Mathew S. Nasopharyngeal tuberculosis. Med J Armed Forces India 2016; 71:S586-9. [PMID: 26858499 DOI: 10.1016/j.mjafi.2014.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 12/15/2014] [Indexed: 11/17/2022] Open
Affiliation(s)
- R K Mishra
- Classified Specialist (ENT), Military Hospital Kirkee, Pune 411020, India
| | - B K Prasad
- Classified Specialist (ENT), Military Hospital Kirkee, Pune 411020, India
| | - Sunil Mathew
- Resident (ENT), Armed Forces Medical College, Pune 411040, India
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10
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Nasopharyngeal tuberculosis mimicking nasopharyngeal carcinoma on (18)F-FDG PET/CT in a young patient. Clin Nucl Med 2015; 40:518-20. [PMID: 25546210 DOI: 10.1097/rlu.0000000000000656] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 30-year-old woman presented with a painless left upper neck swelling for more than a week. Fibrolaryngoscope examination suggested nasopharyngeal carcinoma. FDG PET/CT was performed for an initial staging, which revealed intense activity in the soft tissue mass in the nasopharynx and cervical lymph nodes. However, biopsy from the nasopharyngeal lesion demonstrated tuberculosis.
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11
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Gilbert T, Chidiac C, Bonnefoy M, Ferry T. Tuberculosis of the cavum revealed by acute facial pain. BMJ Case Rep 2015; 2015:bcr-2015-211294. [PMID: 26567238 DOI: 10.1136/bcr-2015-211294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An 85-year-old woman presented for assessment of recurring episodes of intense hemifacial pain, mimicking trigeminal neuralgia, associated with tinnitus. A necrotic tumour of the cavum with compression of the left Eustachian tube and skull-base invasion was discovered on brain MRI. Although the tumour was initially thought to be malignant, the histopathological findings on the biopsy were compatible with tuberculosis, later confirmed by the cultures. F-18-fluorodeoxyglucose positron emission tomography (PET)/CT showed an intense signal of the cavum, cervical and mediastinal lymph nodes, and also of two small nodules of the apex of each lung. Currently, after 9 months of combined antituberculosis antibiotics, the initial lesion has almost disappeared from both PET scan and MRI. This case highlights the importance of systematically screening for tuberculosis in the assessment of nasopharyngeal tumours.
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Affiliation(s)
- Thomas Gilbert
- Service de Médecine Gériatrique, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Christian Chidiac
- Service de Maladies Infectieuses, Centre Hospitalier de la Croix-Rousse, Hospices Civils de Lyon, France
| | - Marc Bonnefoy
- Service de Médecine Gériatrique, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Tristan Ferry
- Service de Maladies Infectieuses, Centre Hospitalier de la Croix-Rousse, Hospices Civils de Lyon, France
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12
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Basal Y, Ermişler B, Eryilmaz A, Ertuğrul B. Two rare cases of head and neck tuberculosis. BMJ Case Rep 2015; 2015:bcr-2015-211897. [PMID: 26498669 DOI: 10.1136/bcr-2015-211897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Tuberculosis is an infectious disease, which is the leading cause of mortality and morbidity and is still a serious health concern. The fact that extra pulmonary tuberculosis does not have specific examination and radiographic findings and that clinical findings vary depending on the organ in which it is detected cause diagnostic difficulties. The head and neck region is an uncommon site for tuberculosis and tuberculosis can localise in many different places of the head and neck region. In this article, the authors present a case of nasopharyngeal tuberculosis, which clinically mimics nasopharyngeal carcinoma and rare cutaneous tuberculosis of the pinna. A wide knowledge of head and neck tuberculosis, including the disease in the differential diagnosis and carrying out microbiological examinations are necessary for accurate diagnosis.
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Affiliation(s)
- Yesim Basal
- Department of Otorhinolaryngology, Adnan Menderes University, Aydın, Turkey
| | - Barış Ermişler
- Department of Otorhinolaryngology, Adnan Menderes University, Aydın, Turkey
| | - Aylin Eryilmaz
- Department of Otorhinolaryngology, Adnan Menderes University, Aydın, Turkey
| | - Bülent Ertuğrul
- Department of Infectious Diseases and Clinical Microbiology, Adnan Menderes University, Aydın, Turkey
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13
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Touati MM, Darouassi Y, Chihani M, Lakouichmi M, Tourabi K, Ammar H, Bouaity B. [ENT primitive extranodal tuberculosis: about 15 cases]. Pan Afr Med J 2014; 19:179. [PMID: 25815100 PMCID: PMC4366124 DOI: 10.11604/pamj.2014.19.179.4597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/30/2014] [Indexed: 11/11/2022] Open
Abstract
Les localisations ORL extra ganglionnaires de la tuberculose sont rares. La symptomatologie clinique ainsi que les examens paracliniques sont souvent trompeurs,posant ainsi le problème de diagnostic différentiel avec la pathologie tumorale. Nous rapportons 15 cas de localisations extra ganglionnaires de tuberculose, colligés au service ORL et CCF de l'Hopital Militaire Avicenne de Marrakech colligés entre 2009 et 2013. L’âge moyen de nos patients est de 33 ans. L’étude topographique a montré 6 cas au niveau du cavum, un cas de miliaire tuberculeuse pharyngée, 4 cas laryngés; 2 localisations auriculaires; 1 parotidienne et 1 localisation sous maxillaire. Le diagnostic était anatomopathologiquedans tous les cas. Tous nos patients ont reçu un traitement antituberculeux avec une bonne évolution. Mots-clés: Tuberculose, amygdale, rhinopharynx, larynx, glandes salivaires,Oreille moyenne.
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Affiliation(s)
- Mohamed Mliha Touati
- Service d'Oto-rhino-laryngologie et Chirurgie Cervico-Faciale, Hôpital Militaire Avicenne, Marrakech, Maroc
| | - Youssef Darouassi
- Service d'Oto-rhino-laryngologie et Chirurgie Cervico-Faciale, Hôpital Militaire Avicenne, Marrakech, Maroc
| | - Mehdi Chihani
- Service d'Oto-rhino-laryngologie et Chirurgie Cervico-Faciale, Hôpital Militaire Avicenne, Marrakech, Maroc
| | - Mohammed Lakouichmi
- Service de Chirurgie Maxillo-Faciale et Plastique, Hôpital Militaire Avicenne, Marrakech, Maroc
| | - Khalid Tourabi
- Service de Chirurgie Maxillo-Faciale et Plastique, Hôpital Militaire Avicenne, Marrakech, Maroc
| | - Haddou Ammar
- Service d'Oto-rhino-laryngologie et Chirurgie Cervico-Faciale, Hôpital Militaire Avicenne, Marrakech, Maroc
| | - Brahim Bouaity
- Service d'Oto-rhino-laryngologie et Chirurgie Cervico-Faciale, Hôpital Militaire Avicenne, Marrakech, Maroc
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14
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Ribeiro S, Ferreira B, Duarte R, Almeida I, Vasconcelos C. Primary nasal tuberculosis during anti-tumour necrosis factor alpha treatment of a patient with rheumatoid arthritis. ACTA ACUST UNITED AC 2013; 45:957-60. [PMID: 23957541 DOI: 10.3109/00365548.2013.818246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Anti-tumour necrosis factor alpha (anti-TNFα) therapy is increasingly used in several inflammatory disease processes, including rheumatoid arthritis. However it has a significant potential for adverse events, such as reactivation of latent tuberculosis, which is frequently found in disseminated or extrapulmonary forms. We present a rare case of primary nasal tuberculosis within the context of anti-TNFα therapy for rheumatoid arthritis. To our knowledge, this is the first reported case of primary nasal tuberculosis in a patient with rheumatoid arthritis receiving anti-TNFα therapy.
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Affiliation(s)
- Sofia Ribeiro
- Department of Internal Medicine, Hospital Santo António, Centro Hospitalar do Porto , Portugal
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15
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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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16
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Touati M, Aljalil A, Chihani M, Bouchentouf R, Bouaity B, Ammar H. [Pseudotumor form of primary nasopharyngeal tuberculosis: apropos of 2 new cases and review of the literature]. Pan Afr Med J 2013; 14:63. [PMID: 23565310 PMCID: PMC3617619 DOI: 10.11604/pamj.2013.14.63.1325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 09/24/2012] [Indexed: 11/17/2022] Open
Abstract
La tuberculose primitive du nasopharynx est rare, nous présentons deux observations révélées par un aspect pseudo tumoral et à travers lesquelles nous soulevons le problème de diagnostic différentiel avec les lésions malignes du nasopharynx. La première observation concerne un jeune patient de 22 ans hospitalisé pour obstruction nasale bilatérale évoluant dans un contexte d'apyrexie et de conservation de l’état général. La nasofibrosopie et le scanner ont monté un processus tumoral évoquant une hypertrophie des végétations adénoïdes. Le deuxième cas est celui d'un homme de 45 ans tabagique chronique qui a présenté une adénopathie latérocervicale droite, une obstruction nasale et une otite séromuqueuse homolatérale. La nasophibroscopie et le scanner on montré un bourgeon tumoral postéro latéral droit du nasopharynx évoquant un carcinome nasopharyngé. Les biopsies du nasopharynx et les études histologiques, chez les deux patients, ont confirmé le diagnostic de tuberculose. La recherche d'autres localisations était négative. Le pronostic était favorable après 6 mois de traitement antibacillaire. La tuberculose primitive du cavum est rare, elle revêt le plus souvent des formes pseudotumorales et pose des problèmes de diagnostic différentiel avec les tumeurs nasopharyngées, son pronostic sous traitement antibacillaire est.
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Affiliation(s)
- Mohammed Touati
- Service ORL et CCF, Hôpital Militaire Avicenne de Marrakech, Morocco
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17
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Patil C, Kharat (Patil) R, Deshmukh P, Biswas J, John B. Primary tuberculosis of nasopharynx (adenoid)– A rare presentation. ASIAN PAC J TROP MED 2013; 6:246-8. [DOI: 10.1016/s1995-7645(13)60033-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 12/31/2012] [Accepted: 01/05/2013] [Indexed: 10/27/2022] Open
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18
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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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Markowski J, Witkowska M, Gierek T, Pasternak K, Ciupińska-Kajor M, Kajor M, Paluch J, Smółka K. [Head and neck tuberculosis - still current problem in ENT practice]. Otolaryngol Pol 2011; 65:272-5. [PMID: 22000144 DOI: 10.1016/s0030-6657(11)70689-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 05/26/2011] [Indexed: 11/17/2022]
Abstract
INTRODUCTION It is estimated that between XVI and XIX century one fourth of European population died of tuberculosis. Nowadays tuberculosis is still one of the most important infectious diseases. In 2009 estimately 9 million new cases were registered worldwide, mortality due tuberculosis reached 1.5 million. In Poland extrapulmonary tuberculosis is rare (7% of overall morbidity) and most commonly affects pleura, lymph nodes, bones, joints and genitourinary system. Head and neck tuberculosis is rare and causes many diagnostics problems. METHODS Retrospective analysis of case histories of patients admitted to ENT Department of Silesian Medical University in Katowice. RESULTS Between 1993 and 2010 four cases of head and neck tuberculosis were diagnosed in our Clinic. Two of patients were admitted to the hospital with symptoms of laryngeal tumor such as difficulty in swallowing. During direct laryngoscopy tissue specimens were taken. Examination of the third patient showed tumor located below left angle of mandibule. During superficial parotidectomy tumor was removed. In the fourth registered case tuberculosis manifested as tumor of nasopharynx. In every case which is mentioned above pathology reports revealed epithelioid cell granulomas with caseous necrosis typical for tuberculosis. Patients underwent tuberculostatic treatment. CONCLUSION Rare occurrence and lack of characteristic symptoms of head and neck tuberculosis often lead to misdiagnosis. Histopathological examination is the most important diagnostic procedure. Microbiological examination is difficult in extrapulmonary tuberculosis, because of low concentration of pathogens in specimens. Tuberculostatic therapy is the leading method of treatment in every case of tuberculosis.
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Martínez A, Lede Á, Fernández JA. Primary Rhinopharyngeal Tuberculosis: An Unusual Location. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2011. [DOI: 10.1016/j.otoeng.2010.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Sachse F, Stoll W. Nasal surgery in patients with systemic disorders. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2011; 9:Doc02. [PMID: 22073106 PMCID: PMC3199829 DOI: 10.3205/cto000066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Multisystemic disorders represent a heterogenous group of diseases which can primarily manifest at the nose and paranasal sinuses as limited disease or secondarily as part of systemic involvement. Rhinologists therefore play an important role in the diagnostic but also therapeutic process. Although therapy of multisystemic disorders is primary systemic, additional rhinosurgery may become necessary. The spectrum of procedures consists of sinus surgery, surgery of the orbit and lacrimal duct, septorhinoplasty and closure of nasal septal perforation. Since the prevalence of most systemic diseases is very rare, recommendations are based on the analysis of single case reports and case series with a limited number of patients only. Although data is still limited, experiences published so far have shown that autologous cartilage or bone grafts can be used in nasal reconstruction of deformities caused by tuberculosis, leprosy, Wegener’s granulomatosis, sarcoidosis and relapsing polychondritis. Experiences gained from these diseases support the concept that well-established techniques of septorhinoplasty can be used in systemic diseases as well. However, a state of remission is an essential condition before considering any rhinosurgery in these patients. Even under these circumstances revision surgery has to be expected more frequently compared to the typical collective of patients undergoing septorhinoplasty. In addition, experiences gained from saddle nose reconstruction may in part be of value for the treatment of nasal septal perforations since implantation of cartilage grafts often represents an essential step in multilayer techniques of closure of nasal septal perforations. Aside from the treatment of orbital complications sinus surgery has been proven beneficial in reducing nasal symptoms and increasing quality of life in patients refractory to systemic treatment.
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Affiliation(s)
- Florian Sachse
- University of Münster, Department of Otorhinolaryngology Head and Neck Surgery, Münster, Germany
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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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Martínez A, Lede A, Fernández JA. [Primary rhinopharyngeal tuberculosis: an unusual location]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010; 62:401-3. [PMID: 21168119 DOI: 10.1016/j.otorri.2010.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 05/25/2010] [Accepted: 06/02/2010] [Indexed: 11/29/2022]
Abstract
We describe a primary rhinopharyngeal tuberculosis case in a woman who presented with an asymptomatic mass found incidentally on a MRI scan. Histopathological examination of the biopsy specimen showed granulomatous inflammation and caseous necrosis. Anti-tuberculosis therapy was applied for a 6-month period, after which nasopharyngeal examination was normal. This case supports the necessity of including tuberculosis in the differential diagnosis for a rhinopharyngeal mass.
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Affiliation(s)
- Alfonso Martínez
- Servicio de Otorrinolaringología, Hospital da Costa, Burela (Lugo), España.
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Yosunkaya S, Ozturk K, Maden E, Cetin T. Primary nasopharyngeal tuberculosis in a patient with symptoms of obstructive sleep apnea. Sleep Med 2008; 9:590. [DOI: 10.1016/j.sleep.2007.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Revised: 07/18/2007] [Accepted: 07/24/2007] [Indexed: 11/26/2022]
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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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