Yong-Cai Liu, Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, HangZhou 310003, Zhejiang Province, China
Min-Li Zhou, Ke-Jia Cheng, Shui-Hong Zhou, Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Xue Wen, Department of Pathology, The First Affiliated Hospital, Medical College, Zhejiang University, Hangzhou 310000, Zhejiang Province, China
Author contributions: Liu YC contributed to data collection, paper review, initial manuscript writing and editing; Liu YC, Cheng KJ, and Zhou SH contributed to conceptualization, final manuscript draft and corrections; Liu YC, Zhou ML, Cheng KJ, and Wen X contributed to clinical examination, surgery, and patient follow up; All authors have read and agreed to the published version of the final manuscript.
Supported byDepartment of Health of Zhejiang Province, No. 2019-KY1-001-138; and Zhejiang Provincial Natural Science Foundatio, No. LTGY24H160016.
Informed consent statement: Consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Ke-Jia Cheng, MD, Chief Doctor, Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. 1505026@zju.edu.cn
Received: March 10, 2024 Revised: April 24, 2024 Accepted: May 6, 2024 Published online: June 16, 2024 Processing time: 86 Days and 3.9 Hours
Abstract
BACKGROUND
Primary nasal tuberculosis (TB) is a rare form of extrapulmonary TB, particularly in patients receiving anti-tumor necrosis factor (TNF) immunotherapy. As a result, its diagnosis remains challenging.
CASE SUMMARY
A 58-year-old male patient presented to the ear, nose, and throat department with right-sided nasal obstruction and bloody discharge for 1 month. He was diagnosed with psoriatic arthritis and received anti-TNF immunotherapy for 3 years prior to presentation. Biopsy findings revealed chronic granulomatous inflammation and a few acid-fast bacilli, suggestive of primary nasal TB. He was referred to our TB management department for treatment with oral anti-TB agents. After 9 months, the nasal lesions had disappeared. No recurrence was noted during follow-up.
CONCLUSION
The diagnosis of primary nasal TB should be considered in patients receiving TNF antagonists who exhibit thickening and crusting of the nasal septum mucosa or inferior turbinate, particularly when pathological findings suggest granulomatous inflammation.
Core Tip: Primary nasal tuberculosis is a rare form of extrapulmonary tuberculosis (TB), particularly in patients receiving anti-tumor necrosis factor immunotherapy. The nasal cavity is most commonly involved; most infections involve the nasal septum and/or the inferior turbinate. We should remain vigilant for primary nasal TB in patients treated with tumor necrosis factor antagonists if the nasal mucosa of the nasal septum or the inferior turbinate demonstrates thickening or crusting, particularly when pathological findings suggest granulomatous inflammation. For suspected cases, repeated biopsies may enhance the identification of acid-fast bacilli.
