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Case Reports
. 2016 Mar 11:16:121.
doi: 10.1186/s12879-016-1449-7.

Primary nasopharyngeal tuberculosis: a case report

Yoshio Nakao  1 , Rei Shibata  2   3 , Toyoaki Murohara  4 , Tohru Tanigawa  5
Affiliations
Case Reports

Primary nasopharyngeal tuberculosis: a case report

Yoshio Nakao et al. BMC Infect Dis. .

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.

Keywords: Nasolaryngoscopy; Nasopharyngeal; Postnasal drips; Tuberculosis.

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Figures

Fig. 1
Fig. 1
Nasopharyngeal tuberculosis. a Nasolaryngoscopic examination showing irregular mucosal thickening of the right lateral and posterior wall of naso (epi)-pharynx, which was covered with yellow discharge presenting as postnasal drip (arrow). b Computed tomography (CT) of the nasopharynx. CT images showing the enhanced soft tissue area in the right lateral and posterior wall of the nasopharynx (arrow). c Histopathological examination of the thickened nasopharyngeal mucosa showing granuloma formation with caseous necrosis. d Ziehl-Nielsen staining from biopsy specimens with acid-fast bacilli (arrow). Chest X-ray e and CT scan f ruled out the pulmonary tuberculosis. g and h Nasolaryngoscopic examination and CT image after 6 months anti-tuberculous therapy showing a normal nasopharynx with complete resolution of the lesion
See this image and copyright information in PMC

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