Tuberculosis of the Sphenoid Sinus Causing Blindness in a Pediatric Patient: A Case Report

Tuberculosis (TB) of the paranasal sinuses is an extremely rare manifestation of extrapulmonary disease, with the sphenoid sinus being the least frequently affected site. Due to its deep anatomical location and proximity to vital neurovascular structures, it often mimics malignancy or fungal infections, frequently leading to delayed diagnosis and severe neurological complications. A 10-year-old male presented with a progressive generalized headache and severe vision loss in his left eye lasting two months. Ophthalmic examination confirmed left-sided optic nerve involvement. Advanced imaging revealed a large lytic mass centered in the sphenoid sinus with erosion of the sella turcica and clivus, bulging into the cavernous sinus and pituitary fossa. Initial endoscopic histopathology showed necrotic granulomatous inflammation but was negative for acid-fast bacilli (AFB). Following a postoperative seizure, endoscopic re-exploration was performed. Cartridge-based nucleic acid amplification testing (CBNAAT) of the tissue returned positive for Mycobacterium tuberculosis. The patient was initiated on standard four-drug antitubercular therapy (ATT), resulting in improvement in visual acuity to 6/6 at six-month follow-up. Isolated sphenoid sinus tuberculosis is an elusive skull base lesion that demands high clinical suspicion. Early surgical intervention for decompression and tissue diagnosis, combined with prompt initiation of antitubercular therapy, is vital to prevent permanent neuro-ophthalmic deficits.