Tuberculosis of paranasal sinuses

Area of Science:

• Otorhinolaryngology
• Infectious Diseases
• Radiology

Background:

• Tuberculosis (TB) of the paranasal sinuses is an exceptionally rare manifestation of Mycobacterium tuberculosis infection.
• While maxillary sinus involvement is most common, concurrent frontal and maxillary sinus TB is exceedingly uncommon.
• Nasal TB can present insidiously, often mimicking more common sinonasal pathologies.

Purpose of the Study:

• To report an unusual case of concurrent tuberculosis affecting the frontal and maxillary sinuses.
• To emphasize the diagnostic challenges and the importance of considering TB in endemic areas.
• To highlight the successful management of sinonasal TB with standard antitubercular therapy.

Main Methods:

• Case presentation of a 68-year-old male with a left medial canthus swelling.
• Initial clinical and radiological evaluation suggested a frontal mucocele with maxillary haziness.
• Diagnosis confirmed via Fine Needle Aspiration Cytology (FNAC), Ziehl-Neelsen staining of nasal swabs, and tuberculin skin testing.

Main Results:

• The patient presented with a localized swelling, initially misdiagnosed as a mucocele.
• Microbiological confirmation identified Mycobacterium tuberculosis in sinus tissues.
• Chest X-ray revealed pulmonary tuberculosis, indicating the primary source of infection.
• The patient showed a positive response to antituberculosis drug therapy.

Conclusions:

• Sinus tuberculosis, though rare, should be considered in the differential diagnosis of chronic sinonasal conditions, especially in patients with risk factors or suggestive pulmonary findings.
• Early diagnosis through microbiological and immunological tests is crucial for effective management.
• Antitubercular therapy is effective in treating sinonasal tuberculosis, leading to favorable outcomes.