Association of laryngeal and nasopharyngeal tuberculosis: a case report

Abstract

IntroductionTo the best of our knowledge, the association of nasopharyngeal and laryngeal tuberculosis has never been described before in the literature. We report here a first observation.Case presentationWe report the case of a 38-year-old Arab man who presented with an isolated hoarseness. Radiological and endoscopic examinations showed a thickening of the left lateral wall of his nasopharynx and the left vocal cord. Pathology revealed the diagnosis of tuberculosis of both localizations. He received a 6-month antituberculous chemotherapy with a satisfying uneventful evolution.ConclusionsTuberculosis should be considered in the differential diagnosis of soft tissue masses of the head and neck, particularly when the imaging findings and clinical presentation are atypical. The diagnosis of tuberculosis is mainly based on histopathological and/or bacteriological examination.

Nasopharyngeal Tuberculosis: Epidemiology, Mechanism of Infection, Clinical Manifestations, and Management

“…According to the WHO global TB report, the most common coexisting condition for all TB patients was HIV infection which had an influence on treatment outcomes [ 1 ]. But in NPTB, only some of articles mentioned this relationship with good treatment outcomes in all articles whether HIV-positive or HIV-negative [ 11 , 14 , 22 – 24 ]. In addition, NPTB may mimic nasopharyngeal carcinoma (NPC) [ 17 , 25 ] or coexist with other conditions in the head and neck such as laryngeal TB, oropharyngeal TB, and postradiation of NPC [ 22 , 23 , 25 , 26 ].…”

“…Treatment outcomes were worse for HIV-positive TB patients (74%) compared with HIV-negative patients (88%) and mortality was more than three times higher among HIV-positive TB patients [ 1 ]. Although the relationship between NPTB and HIV infection has not been clarified yet, few articles mentioned good treatment outcomes in both HIV-positive and HIV-negative NPTB patients [ 11 , 14 , 22 – 24 ]. However, HIV testing should be performed in every TB cases for reducing the burden of HIV-associated TB patients.…”

“…Histopathology was suggested to be a helpful diagnostic tool. NPTB gross lesions can mimic other nasopharyngeal treatable diseases including NPC, lymphoma, minor salivary gland carcinoma, Wegener's granulomatosis, angiofibroma, fungal infection, sarcoidosis, periarteritis nodosa, leprosy, syphilis, and Castleman's disease [ 22 , 25 , 26 , 34 , 38 , 44 , 47 ]. A typical pathological report for diagnosing NPTB is caseating granulomatous inflammation with multinucleated giant cells of Langhans' type and foreign body giant cells, with or without necrosis [ 25 , 32 , 33 ], although NPC itself can develop a granulomatous reaction, similar to TB, in peritumoral tissue [ 25 , 44 ].…”

“…Furthermore chronic granulomatous inflammation with positive Ziehl-Neelsen staining for acid-fast bacilli or bacterial culture can also be demonstrated [ 11 , 14 , 33 , 44 ]. In addition, the case which is strongly suspicious for TB but negative for bacterial culture, bacterial stain, and polymerase chain reaction (PCR) analysis for M. tuberculosis DNA is helpful [ 2 , 22 , 24 , 25 , 32 ]. Many authors suggested that Ziehl-Neelsen staining for acid-fast bacilli in a histologic section is reliable and sensitive and is faster and less costly than bacterial culture and PCR analysis.…”

“…Many authors suggested that Ziehl-Neelsen staining for acid-fast bacilli in a histologic section is reliable and sensitive and is faster and less costly than bacterial culture and PCR analysis. The latter method should be reserved for the stain negative cases to avoid missing a treatable, potentially lethal infection [ 13 , 20 , 22 , 24 , 25 ].…”