1
|
Penjor D, Pradhan B. Diagnostic dilemma in a patient with nasopharyngeal tuberculosis: A case report and literature review. SAGE Open Med Case Rep 2022; 10:2050313X221131389. [PMID: 36267338 PMCID: PMC9577071 DOI: 10.1177/2050313x221131389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/21/2022] [Indexed: 11/05/2022] Open
Abstract
Tuberculosis remains a major cause of morbidity and mortality globally, with a
global total of about 10 million people falling ill with it in 2020. Until the
coronavirus (COVID-19) pandemic, tuberculosis was the leading cause of death
from a single infectious agent. Nasopharyngeal tuberculosis is a rare type of
extrapulmonary tuberculosis that may be either primary or secondary to pulmonary
tuberculosis. Nasopharyngeal tuberculosis may be mistaken for nasopharyngeal
carcinoma as both conditions may present with a nasopharyngeal mass and cervical
lymph node enlargement. We present a case of nasopharyngeal tuberculosis
secondary to pulmonary tuberculosis who presented without any nasal or
respiratory symptoms. The patient presented with a cervical lymph node
enlargement and a nasopharyngeal mass was detected on nasal endoscopy. Fine
needle cytology from the cervical node and the initial biopsy report from the
nasopharyngeal mass were not confirmatory, causing a diagnostic dilemma. A
repeat biopsy from the nasopharyngeal mass with the demonstration of caseating
granuloma and acid-fast bacilli in the specimen pointed to the diagnosis of
nasopharyngeal tuberculosis. The patient responded well to the standard 6-month
anti-tubercular regimen. Nasopharyngeal tuberculosis may mimic nasopharyngeal
carcinoma and a repeat biopsy may be necessary to confirm the diagnosis.
Collapse
Affiliation(s)
- Dorji Penjor
- Department of Otorhinolaryngology,
Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan,Faculty of Postgraduate Medicine,
Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan,Dorji Penjor, Department of
Otorhinolaryngology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu
11001, Bhutan.
| | - Birendra Pradhan
- Department of Pathology, Jigme Dorji
Wangchuck National Referral Hospital, Thimphu, Bhutan
| |
Collapse
|
2
|
Mocanu AI, Mocanu H, Moldovan C, Soare I, Niculet E, Tatu AL, Vasile CI, Diculencu D, Postolache PA, Nechifor A. Some Manifestations of Tuberculosis in Otorhinolaryngology - Case Series and a Short Review of Related Data from South-Eastern Europe. Infect Drug Resist 2022; 15:2753-2762. [PMID: 35668856 PMCID: PMC9166903 DOI: 10.2147/idr.s367885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/12/2022] [Indexed: 11/23/2022] Open
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.
Collapse
Affiliation(s)
| | - Horia Mocanu
- Department of ENT & HNS, Faculty of Medicine, “Titu Maiorescu” University, Bucharest, Romania
| | - Cosmin Moldovan
- Faculty of Medicine, “Titu Maiorescu” University of Bucharest, Bucharest, Romania
- General Surgery Ward, ‘Witting’ Clinical Hospital, Bucharest, Romania
| | - Ioana Soare
- Faculty of Medicine, “Titu Maiorescu” University of Bucharest, Bucharest, Romania
| | - Elena Niculet
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica - CIM-CID), “Dunărea de Jos” University, Galați, Romania
| | - Alin Laurentiu Tatu
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica - CIM-CID), “Dunărea de Jos” University, Galați, Romania
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Claudiu Ionut Vasile
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Daniela Diculencu
- Medical Analysis Laboratory, Clinical Pneumoftisiology Hospital, Iasi, Romania
| | - Paraschiva A Postolache
- Clinical Medical Department, Faculty of Medicine, “Grigore T Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Alexandru Nechifor
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| |
Collapse
|
3
|
Keikha M, Askarizadeh F, Sasan MS, Joghatayee H, Soleimanpour S. The rare multidrug cervical tubercular lymphadenitis in an infant from Iran: A case report and literature review. Clin Case Rep 2021; 9:681-685. [PMID: 33598225 PMCID: PMC7869405 DOI: 10.1002/ccr3.3612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/08/2020] [Accepted: 09/28/2020] [Indexed: 02/05/2023] Open
Abstract
Cervical-TB lymphadenitis is the most frequent extrapulmonary manifestation of tuberculosis infection. There are limited documents (only five documents) on multidrug-resistant cervical tubercular lymphadenitis, but there is no evidence for MDR-cervical tuberculosis lymphadenitis in infants, which may occur in TB endemic regions.
Collapse
Affiliation(s)
- Masoud Keikha
- Antimicrobial Resistance Research CenterBu‐Ali Research InstituteMashhad University of Medical SciencesMashhadIran
- Department of Microbiology and VirologyFaculty of MedicineMashhad University of Medical SciencesMashhadIran
- Tuberculosis Reference LaboratoryMashhad University of Medical SciencesMashhadIran
| | - Fatemeh Askarizadeh
- Antimicrobial Resistance Research CenterBu‐Ali Research InstituteMashhad University of Medical SciencesMashhadIran
- Department of Microbiology and VirologyFaculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Mohammad Saeed Sasan
- Department of PediatricsFaculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Hossein Joghatayee
- Department of PediatricsFaculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Saman Soleimanpour
- Antimicrobial Resistance Research CenterBu‐Ali Research InstituteMashhad University of Medical SciencesMashhadIran
- Department of Microbiology and VirologyFaculty of MedicineMashhad University of Medical SciencesMashhadIran
- Tuberculosis Reference LaboratoryMashhad University of Medical SciencesMashhadIran
| |
Collapse
|
4
|
Zang J, Tian Y, Jiang X, Lin XY. Appearance and morphologic features of laryngeal tuberculosis using laryngoscopy: A retrospective cross-sectional study. Medicine (Baltimore) 2020; 99:e23770. [PMID: 33371143 PMCID: PMC7748357 DOI: 10.1097/md.0000000000023770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/16/2020] [Indexed: 12/23/2022] Open
Abstract
Laryngeal tuberculosis (LTB) is highly contagious and can cause permanent laryngeal damage. Therefore, correctly identifying laryngoscopic LTB lesion locations, sizes, and morphologic features are essential for LTB diagnoses. This study aimed to explore the appearance and morphologic features of LTB and correlated these features with clinical symptoms.We retrospectively analysed 39 LTB patients in our hospital between January 2013 and December 2019. Medical records, including clinical presentation, lesion appearance (locations, sizes, and morphology), complementary examination results, and histopathologic features were summarized and analysed.In this patient cohort, dysphonia and sore throat were the two most common clinical symptoms. In LTB patients with extensive lesions, ulcerative lesions were most common, and the proportion of cases with concurrent pulmonary tuberculosis (86.4%, P = .033) infection was higher, as were the positive rates of sputum smears (72.7%, P = .011) and cultures (86.4%, P = .002) than patients without concurrent pulmonary TB and with more localized and exophytic lesions. The histopathologic features of LTB-related ulcerative lesions included fewer granulomas and more areas with caseous necrosis. These lesions were more likely to have acid-fast bacilli detected with a Ziehl-Neelsen stain than exophytic lesions that rarely showed detectable bacilli.A complete knowledge regarding the visual and morphologic features of LTB on laryngoscopy is needed for the early detection and diagnosis of LTB. Our study revealed the lesion sites, sizes, and morphologic features of LTB. These parameters were also correlated with patient clinical symptoms. Future studies are needed to support and expand the results of this retrospective study.
Collapse
Affiliation(s)
- Jian Zang
- Department of Otolaryngology, The First Affiliated Hospital, China Medical University, Shenyang
| | - Ying Tian
- Department of Otolaryngology, The First Affiliated Hospital, China Medical University, Shenyang
| | - Xuejun Jiang
- Department of Otolaryngology, The First Affiliated Hospital, China Medical University, Shenyang
| | - Xu-Yong Lin
- Department of Pathology, The First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, Liaoning, China
| |
Collapse
|
5
|
Head and neck tuberculosis: Literature review and meta-analysis. Tuberculosis (Edinb) 2019; 116S:S78-S88. [DOI: 10.1016/j.tube.2019.04.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 11/12/2018] [Indexed: 12/13/2022]
|
6
|
An eight-year epidemiologic study of head and neck tuberculosis in Texas, USA. Tuberculosis (Edinb) 2019; 116S:S71-S77. [PMID: 31060959 DOI: 10.1016/j.tube.2019.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 11/09/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Head and neck tuberculosis (HNTB) especially cervical lymphadenopathy are the most common extrapulmonary indications of TB, but remain a diagnostic challenge. In this study, we describe and analyze the epidemiologic characteristics of HNTB on a population-level. MATERIALS AND METHODS We retrospectively assessed 547 HNTB cases reported to the Centers for Disease Control and Prevention's TB Genotyping Information Management System in Texas from 2009 to 2016 and compare and contrast differences between diagnosed exclusively HNTB and HNTB with concurrent pulmonary tuberculosis (PTB). RESULTS The majority of patients with HNTB were diagnosed with cervical lymphadenopathy (96.9%), age 25-44 (47.3%) and female (52.7%). Co-infection with human immunodeficiency virus, being homeless, excessive alcohol use within the past 12 months and drug use were more frequently seen for HNTB with concurrent pulmonary involvement compared to reported patients with exclusively HNTB. The highest prevalence of Mycobacterium tuberculosis lineage in exclusively HNTB was Euro-American L4 (52.3%), followed by Indo-Oceanic L1 (21.5%) and East-Asian L2 (13.1%). One multidrug resistant TB case was identified. Seven deaths were reported during treatment. CONCLUSION Our findings provide a better understanding of the epidemiology of HNTB and characteristics associated with the disease at the population-level, which is important in managing HNTB patients.
Collapse
|
7
|
An ulcer on the ventral tip of tongue. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 127:92-96. [PMID: 29653816 DOI: 10.1016/j.oooo.2018.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/04/2018] [Accepted: 01/19/2018] [Indexed: 12/16/2022]
|
8
|
Clinical study of tuberculosis in the head and neck region-11 years' experience and a review of the literature. Emerg Microbes Infect 2018; 7:4. [PMID: 29323108 PMCID: PMC5837174 DOI: 10.1038/s41426-017-0008-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 11/07/2017] [Indexed: 12/27/2022]
Abstract
Tuberculosis (TB) is an infectious disease and major health concern. Head and neck tuberculosis (HNTB) is relatively rare, but can arise in many regions, including the lymph nodes, larynx, oral cavity and pharynx. We retrospectively reviewed the clinical records of 60 patients diagnosed with HNTB in our department between March 2005 and January 2016. A review and summary of previous HNTB articles published in PubMed since 1885 was also performed. The subjects consisted of 17 males and 43 females, and the average age of patients was 45 ± 14.67 years. The major clinical presentation was a lump or swelling, followed by an oral ulcer and skin fistula. The most common site of tuberculosis was in the cervical lymph node. Three patients also suffered from a malignant tumor in the head and neck region. A total of 980 papers involving 5881 patients were included in our literature review. The included subjects ranged in age from 15 months to 100 years with a male-to-female ratio of 1.5:1. The larynx (38.92%), cervical lymph nodes (38.28%) and oral cavity (9.92%) were the three most common development sites. 465 patients were positive according to a HIV test, and 40 patients had comorbidities with different types of tumors. Head and neck tuberculosis should always be considered during a differential diagnosis for lesions in the head and neck region. Early diagnosis and treatment can greatly enhance the therapeutic effect and patients’ quality of life.
Collapse
|
9
|
Diagnostic challenges in cervical tuberculous lymphadenitis: A review. North Clin Istanb 2016; 3:150-155. [PMID: 28058405 PMCID: PMC5206468 DOI: 10.14744/nci.2016.20982] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 06/23/2016] [Indexed: 11/20/2022] Open
Abstract
Tuberculosis is a very serious disease and incidence is once again on the rise. Lymph node tuberculosis is one of the most common extrapulmonary manifestations of tuberculosis. In differential diagnosis of chronic, painless cervical lymphadenopathy, cervical tuberculous lymphadenitis should be kept in mind. A high index of suspicion is needed for diagnosis of tuberculous lymphadenitis, which is known to mimic a number of pathological conditions. This article reviews epidemiology, clinical manifestations, and diagnostic techniques for cervical tuberculous lymphadenitis.
Collapse
|