Acute miliary tuberculosis of the pharynx (Isambert disease): case report

Miliary pharyngeal tuberculosis or Isambert disease is a rare form of tuberculosis. It can be isolated or more often associated with lung damage. We report the case of a 25-year-old patient referred for deep asthenia with fever, sweating and weight loss, all associated with dysphagia and hearing loss. The pharyngeal examination found an oropharyngeal miliary and an involvement of the cavum. Chest computed tomography (CT) showed excavated lesions suggestive of tuberculosis. The clinical situation clearly improved with anti-tuberculous treatment. Isambert disease is a rare pharyngeal disorder occurring especially at extreme ages or in immunocompromised patients. The contamination is either direct or hematogenous. The pharyngeal examination finds grayish tubers on an often congestive mucosa. The diagnosis is bacteriological and/or histological. Treatment is mainly medical, more rarely surgical. The general assessment aims to find other locations. The miliary pharyngeal tuberculosis is rare and must make seek other locations. The diagnosis is easy and treatment mainly medical. The consequences can be significant.