A Case of Nasopharyngeal Tuberculosis

Introduction: Nasopharyngeal tuberculosis is rare even in endemic tuberculosis areas.

Presentation of Case: A 22 year old woman presented with right neck swelling for 3 weeks. She worked as a chest clinic nurse. Examination revealed a right level II and III cervical neck swellings Rigid nasoendoscopy revealed a huge friable nasopharyngeal mass. Biopsy of the nasopharyngeal mass showed caseating granulomatous inflammation. Cytology of the lymph node revealed granulomatous lymphadenitis. Contrasted CT showed fullness of the nasopharynx with cervical lymphadenopathy. No pulmonary lesions were found. Patient has been started on anti-Tuberculous drugs and after treatment the lesion disappeared. Nasopharyngeal tuberculosis is a rare and unique variation of tuberculosis. The most common presenting symptom is neck lymph node enlargement followed by nasal obstruction. Such a presentation together with the findings of a nasopharyngeal mass makes it indistinguishable from nasopharyngeal carcinoma especially in endemic areas. It is therefore of utmost importance that a nasopharyngeal biopsy is done which will show caseating granulomatous inflammation characteristic of tuberculosis. It is considered an extrapulmonary tuberculosis and responds well to a minimum of 6 months duration of treatment with anti-Tuberculous drugs.

Conclusion: Histological studies are important in patients presenting with cervical neck swelling and nasopharyngeal mass. This is especially important in places where nasopharyngeal carcinoma and tuberculosis is endemic such as Southeast Asia.