J Rhinol.  2024 Jul;31(2):119-123. 10.18787/jr.2024.00016.

A Case of Primary Tuberculosis of the Paranasal Sinuses

• Yoo SJ
• Min HK
• Kim SW
• Min JY

• KMID: 2558239
• DOI: http://doi.org/10.18787/jr.2024.00016

Abstract

Tuberculosis of the paranasal sinus is a rare disease caused by infection with Mycobacterium tuberculosis, the causative agent of pulmonary tuberculosis. Although the worldwide incidence of tuberculosis is declining, the diagnosis of primary paranasal tuberculosis remains challenging and cannot be ruled out in patients presenting with refractory chronic rhinosinusitis after adequate surgical and medical treatment. We experienced a case of paranasal tuberculosis with no evidence of previous tuberculosis infection. It was diagnosed after a surgical biopsy revealed granulomatous inflammation and caseous necrosis. The patient responded well to antituberculosis drug therapy and became free of symptoms after 7 months of treatment. We report our findings in this case with a review of the recent literature.

Keyword

Tuberculosis; Paranasal sinus; Nasal cavity

Figure

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  Fig. 1. Preoperative computed tomography (CT) images. Coronal view (A) and axial view (B) of CT of the paranasal sinus showing heterogenous soft tissue density in the left maxillary, anterior ethmoid, and frontal sinuses with the left middle ear cavity.

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  Fig. 2. Intraoperative endoscopic findings of the nasal cavity and nasopharynx, showing granulomatous inflammation with necrosis.

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  Fig. 3. Hematoxylin and eosin-stained section of the nasal mucosa (×100). Infiltrations with lymphocytes, macrophages, and possible multinucleated giant cells, and caseating necrosis (a form of cell death where the tissue turns into a soft, white, and cheese-like material) were shown (marked by arrow line).

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  Fig. 4. Postoperative endoscopic findings showing the remaining ulcerative lesion with necrosis.

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  Fig. 5. Improved state of the postoperative wound after antituberculosis therapy.

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