Some Manifestations of Tuberculosis in Otorhinolaryngology - Case Series and a Short Review of Related Data from South-Eastern Europe

Abstract

Tuberculosis is a disease of global outreach that may affect the entire human body but is most commonly located in the lungs. Otorhinolaryngological manifestations of tuberculosis are rare, mostly occurring secondary to pulmonary disease but nevertheless represent significant diagnostic challenges. Nasopharyngeal tuberculosis is rare, representing around 1% of all upper air-way localizations and the most common presentation is in the form of adenoids. Tuberculous glossitis (oral tuberculosis) is even scarcer and may present in various clinical forms, usually mimicking a malignant neoplasm, or, less often, trauma or other infectious lesions. Oropharynx tuberculosis is usually misdiagnosed as hypertrophic chronic tonsillitis. We present four rare cases of ENT tuberculosis, primary adenoiditis and tonsillitis in a 13-year-old girl, a curious case of tuberculous glossitis in a 65-year-old woman, clinically diagnosed as a lingual neoplasm and two cases of tuberculous lymphadenopathy uncommonly located in the submandibular and supraclavicular regions. A comprehensive review of literature follows the case presentations. Tuberculous manifestation in the ear, nose and throat area remains a difficult diagnosis to establish, particularly because of its rarity and non-specific clinical appearance, and should be included in the differential diagnosis of pharynx lesions. An early diagnosis is essential to avoid occurrence of complications.

Keywords: case report; extra nodal; head and neck; nasopharynx; oral tuberculosis; tuberculosis.

Figure 1

Gross examination of the palatine and pharyngeal tonsils, all with an unusually grey-yellowish, elastic, almost cartilaginous aspect.

Figure 2

Clinical examination of the tongue revealing a nodular, ulcerated, infiltrating mass on the left side, extending inferiorly towards the ventral surface.

Figure 3

Microscopic examination revealing numerous caseous and non-caseous epithelioid and giant cell granulomas. (hematoxylin-eosin, 40x).

Figure 4

Ziehl-Neelsen special stain revealing acid-fast bacilli (pink rods on a blue background).

Figure 5

Clinical examination of a round, mobile, submandibular tumor.

Figure 6

Microscopic examination revealing epithelioid granulomas of various shapes and sizes, necrosis, giant multinucleated cells (Langhans giant cells).

Figure 7

Defective wound healing.