Hemant Chopra, Vanita Chopra.
Primary Tuberculosis of the Nose and Paranasal Sinuses.
Pak J Otolaryngol Jan ;18(2):32-4.

Tuberculosis is a chronic bacterial infection caused by Mycobacterium tuberculae and is characterized by the formation of caseating granulomas in infected tissues by cell mediated hypersensitivity, though primary tuberculosis of the sinonasal tract is considered infrequent, it is practical to keep the disease in mind in any case of undiagnosed clinical infection or inflammatory disease. Any undiagnosed pathology of the sinonasal tract should be suspected to be a case of tuberculosis until proved otherwise. Key Words: Tuberculosis, Sinonasal, Pathology.

CASE REPORT: G.S. a 40 years old male presented in the ENT ward of Dayanand Medical College and Hospital Ludhiana on 18th Jan 2000 with complaints of left sided progressively increasing nasal obstruction for the past three months and swelling left side of the face for the past forty days. There was no past history suggestive of syphilis, pulmonary tuberculosis, trauma or bleeding from the nose. History regarding pain, nasal discharge, anosmia or other systemic symptoms was negative. Clinical examination revealed a swelling over left half of the face localized to naso-orbital groove causing widening of the gap between bridge of nose and the medial canthus. Swelling was firm, tender and fixed, overlying skin was normal. Alar cartilages were thickened on left side. Nasal cavity revealed a grayish mass arising from the lateral wall of the nose filling almost whole of the nasal cavity upto the inferior meatus. It did not bleed on probing. Right nasal cavity and postnasal space like the rest of the examination did not reveal any abnormality. Routine investigations including x-ray chest were normal, x-ray paranasal sinuses showed haziness of left maxillary sinus and mass in the left nasal cavity with no bony or cartilagenous erosion. CT scan revealed infiltration into the maxillary sinus, ethmoids, lamina papyraecea was pushed laterally, no infilteration into the orbit was seen, sphenoid and frontal sinuses were clear. The mass on biopsy revealed stratified squamous epithelium with focci of ulceration. Dense inflammatory infiltrate composed of lymphocytes and plasma cells, interspersed with Langhans/foreign body giant cells and area of necrosis consistent with tuberculosis were seen. AFB stain for tuberculosis was negative. The nasal mass along with the antral mass was excised endoscopically and a wide antrostomy was made. There was evidence of submucosal spread of the disease. After full surgical debridement, the patient was put on standard antitubercular regime and showed improvement in due course of time and now is symptom free.

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