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Nasopharyngeal tuberculosis suspected of malignancy: A case report
1Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea.
Rationale:
Nasopharyngeal tuberculosis (TB), a rare form of tuberculosis outside the lungs, can affect any organ or tissue in the body. It is difficult to diagnose because of nonspecific symptoms, often leading to delayed confirmation after the initial patient visit. Clinical manifestations such as cervical lymphadenopathy and irregular mucosal surfaces can be challenging to distinguish from nasopharyngeal cancer or malignant lymphoma.
Patient Concerns:
In this case report, we present a patient initially suspected of having a malignant disease based on abnormal nasopharyngeal imaging findings.
Diagnoses:
Further examination revealed chronic granulomatous inflammation, and subsequent tuberculosis polymerase chain reaction (TB-PCR) confirmed the diagnosis of tuberculosis.
Interventions:
The patient is currently receiving anti-TB treatment with a 4-drug regimen, which has shown a good response with continuous reduction in lesion size.
Outcomes:
After anti-TB treatment, the lesion size gradually decreased and continued to decrease, showing a significant response.
Lessons:
Awareness and precise evaluation are key to avoiding misdiagnosis, particularly when confronted with diverse clinical presentations. Extrapulmonary tuberculosis, although relatively rare, presents unique diagnostic challenges. Nasopharyngeal tuberculosis, in particular, lacks a definitive diagnostic method, often necessitating a combination of clinical suspicion, imaging studies, microbiological tests, and histopathological examination for confirmation. The absence of specific symptoms and the variability in presentation further compound the diagnostic dilemma. Given the potential consequences of misdiagnosis, further exploration and discussion on this issue are warranted. Enhanced awareness among healthcare providers, coupled with advancements in diagnostic modalities, are essential in ensuring timely and accurate differentiation between nasopharyngeal malignancies and tuberculosis, thereby facilitating appropriate management and improving patient outcomes.
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