Pulmonary tuberculosis with rhinosinusal and otic manifestations - diagnostic challenge

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Abstract

BACKGROUND. Unfortunately, tuberculosis is still being diagnosed among patients, independent of their age, gender, provenance or social category. The etiologic agent of tuberculosis is Mycobacterium tuberculosis, which is known to have a period of latency between the initial infection and the clinical manifestation. The most common localization is pulmonary, but it can affect, secondarily, other organs, especially in the ENT regions, mimicking other systemic diseases.

MATERIAL AND METHODS. We are presenting a case of a 51-year-old female patient, who was referred to our ENT Clinic with the suspicion of Behcet’s disease with rhinosinusal manifestations. She had a pulmonary assessment in another hospital, as she was known with left lung bronchiectasis, but the sputum samples were negative. The clinical otorhinolaryngologic examination together with the rheumato-logical assessment and the result of the nasal mucosa biopsy were suggestive for Behcet’s disease and the patient received 6 weeks of Prednisolone. The specific immunologic tests (cANCA, pANCA, HLA B51) were negative. The patient returned to our clinic after 2 months, accusing symptomatology reacutization with right otorrhea and bilateral hearing loss aggravation. Nasal and rhinopharyngeal mucosa biopsies were repeated and the anatomopathological result was specific for tuberculosis.

RESULTS. She was referred to the Pneumology Service where she received the diagnosis of pulmonary tuberculosis with rhinosinusal and otic manifestations. Currently, the patient is under tuberculostatic treatment.

CONCLUSION. Extrapulmonary tuberculosis symptoms might be confused with other systemic diseases with rhinosinusal manifestations. Thorough examination and multidisciplinary approach are mandatory in order to establish a correct diagnosis followed by an appropriate treatment.

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  • 1. Daniel TM. The history of tuberculosis. Respir Med. 2006;100(11):1862-70. Epub 2006 Sep 1.

  • 2. WHO Regional Office for Europe/European Centre for Disease Prevention and Control. Tuberculosis surveillance and monitoring report in Europe 2019 – 2017 data. [Internet]. Copenhagen: WHO Regional Office for Europe; 2019. Available from: https://ecdc.europa.eu/sites/portal/files/documents/tuberculosis-surveillance-monitoring-Europe-2019-18_Mar_2019.pdf.

  • 3. European Center for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2015. [Internet]. Available from: https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/tuberculosis-surveillance-monitoring-Europe-2015.pdf.

  • 4. De Colombani P Hollo V Jansen N Kremer K Labelle S Makhmudova M et al. Review of the national tuberculosis programme in Romania. [Internet] WHO Regional Office for Europe; 2015. Available from: https://apps.who.int/iris/handle/10665/149036.

  • 5. Lee JY. Diagnosis and treatment of extrapulmonary tuberculosis. Tuberc Respir Dis (Seoul). 2015;78(2):47–55. DOI: 10.4046/trd.2015.78.2.47.

  • 6. Ramírez-Lapausa M Menéndez-Saldaña A Noguerado-Asensio A. Extra-pulmonary tuberculosis. Rev Esp Sanid Penit. 2015;17(1):3-11. DOI: 10.4321/S1575-06202015000100002.

  • 7. Vital V Printza A Zaraboukas T. Tuberculous otitis media: a difficult diagnosis and report of four cases. Pathol Res Pract. 2002;198(1):31-5.

  • 8. Vaamonde P Castro C Garcia-Soto N Labella T Lozano A. Tuberculous otitis media: a significant diagnostic challenge. Otolaryngol Head Neck Surg. 2004;130(6):759-66.

  • 9. Adhikari P. Tuberculous otitis media: a review of literature. [Internet]. Int J Otorhinolaryngol. 2009;9(1):1528-8420. Available from: https://print.ispub.com/api/0/ispub-article/10058.

  • 10. Goguen LA Karmody CS. Nasal tuberculosis. Otolaryngol Head Neck Surg. 1995;113(1):131–5.

  • 11. Masterson L Srouji I Kent R Bath AP. Nasal tuberculosis–an update of current clinical and laboratory investigation. J Laryngol Otol. 2011;125(2):210–3. DOI: 10.1017/S0022215110002136. Epub 2010 Oct 19.

  • 12. Ryu YJ. Diagnosis of pulmonary tuberculosis: recent advances and diagnostic algorithms. Tuberc Respir Dis (Seoul). 2015;78(2):64–71. DOI: 10.4046/trd.2015.78.2.64.

  • 13. World Health Organization. Early detection of tuberculosis: an overview of approaches guidelines and tools [Internet]. Geneva: World Health Organization; 2011. Available from: https://apps.who.int/iris/handle/10665/70824.

  • 14. Wilson ML. Recent advances in the laboratory detection of Mycobacterium tuberculosis complex and drug resistance. Clin Infect Dis. 2011;52(11):1350–5. DOI: 10.1093/cid/cir146.

  • 15. Iseri M Topdag M Ulubil SA Kuru FD. Bilateral facial paralysis caused by tuberculous otitis media: A case report. Int Adv Otol. 2010;6(3):410-4.

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