Primary Nasal Tuberculosis Masquerading as Granulomatosis With Polyangiitis: A Case Report of Diagnostic Dilemma

Primary nasal tuberculosis (TB) is a rare disease even in areas with high TB burden, possibly attributed to the protective mechanism of sinonasal mucosa. Its symptoms are subtle and can be mistaken for other granulomatous inflammatory conditions. We would like to report a case of a 70-year-old Indian lady who underwent a successful left endoscopic dacryocystorhinostomy three years ago and presented with recurrent left epiphora. During nasal endoscopy, multiple ulcerative masses with crusting were detected over the left nasal vestibule, anterior nasal septum, left inferior, and middle turbinate. Biopsy of the nasal mass revealed granulomatous inflammation without caseating necrosis. Initially, all TB-related tests were negative. As the patient had granulomatous nasal lesions with microscopic haematuria, granulomatosis with polyangiitis (GPA) was suspected. Regrettably, the patient did not respond to treatment. A repeated tissue culture at a later stage finally detected mycobacterium tuberculosis without the presence of pulmonary tuberculosis. Considering the current TB prevalence in the Southeast Asian region, it is crucial for otorhinolaryngologists to be aware of primary nasal TB when encountering unusual head and neck lesions, even in the absence of pulmonary TB.