HEAD & NECK RADIOLOGY
Year : 2008 | Volume
: 18 | Issue : 1 | Page : 63--65
Case report: Nasopharyngeal tuberculosis
BKD Prasad, GS Kejriwal, SN Sahu
Maharajah's Institute of Medical Sciences, Nellimarla, Vizianagaram, India
Flat no-5, First floor, Buddhavarapu Residential Complex, Maharanipeta, Visakhapatnam - 530 002
|How to cite this article:|
Prasad B, Kejriwal G S, Sahu S N. Case report: Nasopharyngeal tuberculosis.Indian J Radiol Imaging 2008;18:63-65
|How to cite this URL:|
Prasad B, Kejriwal G S, Sahu S N. Case report: Nasopharyngeal tuberculosis. Indian J Radiol Imaging [serial online] 2008 [cited 2019 Nov 17 ];18:63-65
Available from: http://www.ijri.org/text.asp?2008/18/1/63/38507
Tuberculosis is a common infectious disease worldwide, including India. It most commonly affects the lungs, though any organ can be affected. Upper respiratory tract involvement is uncommon (1.8%) and involvement of the nasopharynx (0.1%) is rarer still.  Tuberculous involvement of the nasopharynx may be primary, without involvement of any other system, or secondary to pulmonary or extrapulmonary involvement. There is limited description of this entity in the classic otolaryngology textbooks. , We would like to describe a case of primary tuberculous involvement of the nasopharynx.
A 22-year-old man came with a history of nasal obstruction, mouth breathing, and snoring for 3 years. He had no past history of nasal bleeding or any other throat or ear complaints. Clinical examination showed nothing significant. The ESR was elevated to 110 mm/1 h. The Mantoux test showed an induration of 24 mm. The chest radiograph was normal. Nasopharyngeal endoscopy showed a pink, glistening mass involving the whole of the nasopharynx, occluding both choanae [Figure 1].
CT scan showed a moderately enhancing mass, measuring 4.0 × 2.7 × 4.0 cm, in the nasopharyngeal roof, extending up to the posterior choanae bilaterally [Figure 2],[Figure 3]. The surrounding fat planes were well-maintained, without involvement of adjacent structures. The bones were not involved and there was no cervical lymphadenopathy. An endoscopic biopsy showed multiple granulomata, caseous necrosis, Langerhans giant cells, and epitheloid cells. Tissue PCR was positive for tuberculosis.
Isolated nasopharyngeal tuberculosis is a rare condition even in endemic areas.  Primary nasopharyngeal involvement probably occurs due to reactivation of dormant acid fast bacilli in the adenoids or due to direct mucosal infection after inhalation of the bacilli.  It may be commoner than secondary involvement,  which usually occurs in conjunction with pulmonary tuberculosis.
The clinical presentation may vary. The patient may be completely healthy, with no underlying disease and with no history of contact with tuberculosis, or may present with a sore throat.  Other presentations include epistaxis, running nose, postnasal drip, nasal obstruction, and chronic cough. Cervical lymphadenopathy is a common accompaniment,  followed by nasal discharge and obstruction. Tuberculous involvement of the nasopharynx may be underdiagnosed, since it does not produce obvious symptoms and physical signs in all cases.  Atypical presentations with diplopia  and snoring  have also been reported.
Endoscopic examination may reveal a polypoidal mass, ulceration, plaque, or diffuse mucosal thickening. ,, All these findings may suggest nasopharyngeal carcinoma, lymphoma, or Wegener's granulomatosis.  Infections such as syphilis, leprosy, and fungal diseases may have a similar appearance. Tuberculosis may coexist with malignancy  and has even been described after radiotherapy. 
Plain radiographs are usually not useful and may show a nonspecific soft tissue lesion in the nasopharynx or may simulate adenoid hypertrophy in young patients. CT scan commonly shows either diffuse mucosal thickening or a moderately enhancing polypoidal mass in the roof of the nasopharynx, which may be ulcerated.  Necrosis may be seen. MRI commonly shows a mass or diffuse mucosal thickening of intermediate signal intensity on T1W and T2W sequences, with moderate contrast enhancement on T1W images. 
It is difficult to make an accurate diagnosis of nasopharyngeal tuberculosis on imaging findings alone and a biopsy is required to confirm the diagnosis and to differentiate it from malignancy and the other conditions described above.
Since our patient did not have lung involvement or lymphadenopathy, it is likely that this was a case of primary nasopharyngeal tuberculosis.
We would like to thank the Principal and Medical Superintendent, MIMS, for allowing us to send this case report for publication. We also would like to thank the faculty members of the Departments of E.N.T. and Pathology for their excellent support in bringing out this paper.
|1||Rohwedder JJ. Upper respiratory tract tuberculosis: 16 cases in a general hospital. Ann Intern Med 1974;80:708-13.|
|2|| In : Booth JB, Kerr GA, editors. Scott - Brown's "otolaryngology" 6th ed, Vol 5, 5/4/12,19 International edition, K. M. Varghese Company: Mumbai; 1997.|
|3||Cummings CW, Fredrickson JM, Harker LA, Krause CJ, Schuller DE, Richardson MA, editors. Otolaryngology, Head and Neck surgery. 3 rd ed, vol 2. Mosby Publisher: London; 1998.|
|4||Aktan B, Selimoglu E, Oguncu H, Sutbeyaz Y. Primary nasopharyngeal tuberculosis in a patient with the complaint of snoring. J Laryngol Otol 2002;116:301-3.|
|5||Sithinamsuwan P, Sakulsaengprapha A, Chinvarun Y. Nasopharyngeal tuberculosis: A case report presenting with diplopia. J Med Assoc Thai 2005;88:1442-6.|
|6||Waldron J, Van Hasselt CA, Skinner DW, Arnold M. Tuberculosis of nasopharynx: Clinico pathological features. Clin Otolaryngol 1992;17:57-9.|
|7||Madhuri, Chandra Mohan, Sharma ML. Posterior oropharyngeal wall tuberculosis. Indian J Otolaryngol Head Neck Surg 2002;54:152-3.|
|8||King AD, Ahuja AT, Gary MK, Van Hasselt CA, Chan AB. MR imaging features of nasopharyngeal tuberculosis: Report of three cases and literature review. Am J Neuroradiol 2003;24:279-82.|
|9||Tas E, Sahin E, Vural S, Turkoz HK, Gursel AO. Upper respiratory tract tuberculosis: Our experience of three cases and review of article: The internet. J Otorhinolaryngol 2007;6:1.|
|10|| In : Johnson JT, Yu VL, editors. Infectious diseases and anti microbial therapy of Ear, nose and throat. 1 st ed. W.B. Saunders Company: Philadelphia; 1997. p. 206.|
|11||Harrison NK, Knight RK. Tuberculosis of Nasopharynx misdiagnosed as Wegener's granulomatosis. Thorax 1986;41:219-20.|
|12||Raman R, Bakthaviziam A. Tuberculosis associated with malignancy of the nasoparynx. Indian J Otolaryngol 1981;33:149-50|
|13||Chaua BL Tan H, Yang ET. Tuberculosis of nasopharynx following radiotheraphy. Clin Oncol 1998;10:59-61.|