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Primary nasal tuberculosis.

Dixit R, Dave L - Lung India (2008)

View Article: PubMed Central - PubMed

Affiliation: Assistant Professor, Department of Tuberculosis & Chest Diseases, J. L. N. Medical College, Ajmer, (India).

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Tuberculous involvement of nose, nasopharynx and para nasal sinus is extremely rare even in countries with a high incidence of pulmonary disease... It develops, almost always, secondarily to a tuberculous focus elsewhere in the respiratory tract... Although nasal mucosa is inherently very resistant to tubercle bacillus, both trauma and atrophic changes facilitate successful lodging of bacilli within the nasal lining... Mantoux test revealed an induration of 20 mm with blister formation... Nasal endoscopy confirmed the findings of anterior rhinoscopy... Multiple biopsies were obtained from the nasal mass that on histological examination revealed granulomatous inflammation consisting of epitheloid cells, Langhans type giant cells and lymphocytes with areas of micro-caseation... This technique not only allows a more thorough examination of the nasal interior and nasopharynx but also facilitates biopsy of the mucosa or granulomatous mass... The diagnosis of primary nasal tuberculosis in our case was made by demonstration of AFB and typical caseating granulomas in the biopsy tissue from nose along with negative workup for tuberculous foci elsewhere in the body... This is especially important because the differential diagnosis of disease may rest between tuberculosis and midline granulomas (i.e. wegners granulomatosis, leprosy, sarcoidosis, subcutaneous phycomycosis, granulomatous syphilis etc.) or carcinomas... Other differential diagnosis includes rhinoscleroma, rhino- sporidium seeberi, rhinitis sicca, suppurative sinus disease and foreign bodies etc... The management essentially consists of adequate anti-tuberculosis therapy with excisional surgery, if obstruction is significant and reconstruction plastic surgery for perforation of nasal septum and cosmetic purpose if required... This included cleansing irrigations with alkaline antiseptic solutions, tampons of hydrogen peroxide to soften up the dried crusts, application of acids such as lactic, trichloracetic and chromic to the ulcers and use of galvanocautery and diathermy for destruction of the lesions... Other methods such as use of tuberculin, astringent powders (iodobor and aristol) insufflations in nose, pyrogallic ointment insertion in nose etc. along with sunlight, x-rays or ultraviolet rays, all have been used in past in an attempt to cure the disease or prevent extension of infection to the vital areas so as to reduce mortalities... Although these methods were symptomatically helpful, they have little application in modern management of the disease.

No MeSH data available.


Related in: MedlinePlus

Photograph of the patient showing extensive local destruction of columella and nasal septum with nodular granulomas in nasal cavity.
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Figure 0001: Photograph of the patient showing extensive local destruction of columella and nasal septum with nodular granulomas in nasal cavity.


Primary nasal tuberculosis.

Dixit R, Dave L - Lung India (2008)

Photograph of the patient showing extensive local destruction of columella and nasal septum with nodular granulomas in nasal cavity.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2822326&req=5

Figure 0001: Photograph of the patient showing extensive local destruction of columella and nasal septum with nodular granulomas in nasal cavity.

View Article: PubMed Central - PubMed

Affiliation: Assistant Professor, Department of Tuberculosis & Chest Diseases, J. L. N. Medical College, Ajmer, (India).

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Tuberculous involvement of nose, nasopharynx and para nasal sinus is extremely rare even in countries with a high incidence of pulmonary disease... It develops, almost always, secondarily to a tuberculous focus elsewhere in the respiratory tract... Although nasal mucosa is inherently very resistant to tubercle bacillus, both trauma and atrophic changes facilitate successful lodging of bacilli within the nasal lining... Mantoux test revealed an induration of 20 mm with blister formation... Nasal endoscopy confirmed the findings of anterior rhinoscopy... Multiple biopsies were obtained from the nasal mass that on histological examination revealed granulomatous inflammation consisting of epitheloid cells, Langhans type giant cells and lymphocytes with areas of micro-caseation... This technique not only allows a more thorough examination of the nasal interior and nasopharynx but also facilitates biopsy of the mucosa or granulomatous mass... The diagnosis of primary nasal tuberculosis in our case was made by demonstration of AFB and typical caseating granulomas in the biopsy tissue from nose along with negative workup for tuberculous foci elsewhere in the body... This is especially important because the differential diagnosis of disease may rest between tuberculosis and midline granulomas (i.e. wegners granulomatosis, leprosy, sarcoidosis, subcutaneous phycomycosis, granulomatous syphilis etc.) or carcinomas... Other differential diagnosis includes rhinoscleroma, rhino- sporidium seeberi, rhinitis sicca, suppurative sinus disease and foreign bodies etc... The management essentially consists of adequate anti-tuberculosis therapy with excisional surgery, if obstruction is significant and reconstruction plastic surgery for perforation of nasal septum and cosmetic purpose if required... This included cleansing irrigations with alkaline antiseptic solutions, tampons of hydrogen peroxide to soften up the dried crusts, application of acids such as lactic, trichloracetic and chromic to the ulcers and use of galvanocautery and diathermy for destruction of the lesions... Other methods such as use of tuberculin, astringent powders (iodobor and aristol) insufflations in nose, pyrogallic ointment insertion in nose etc. along with sunlight, x-rays or ultraviolet rays, all have been used in past in an attempt to cure the disease or prevent extension of infection to the vital areas so as to reduce mortalities... Although these methods were symptomatically helpful, they have little application in modern management of the disease.

No MeSH data available.


Related in: MedlinePlus