Published online Jun 16, 2024. doi: 10.12998/wjcc.v12.i17.3271
Revised: April 24, 2024
Accepted: May 6, 2024
Published online: June 16, 2024
Processing time: 86 Days and 3.9 Hours
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.
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.
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.