Diagnostic dilemma in a patient with nasopharyngeal tuberculosis: A case report and literature review
Open accessAbstract
Tuberculosis remains a major cause of morbidity and mortality globally, with a global total of about 10 million people falling ill with it in 2020. Until the coronavirus (COVID-19) pandemic, tuberculosis was the leading cause of death from a single infectious agent. Nasopharyngeal tuberculosis is a rare type of extrapulmonary tuberculosis that may be either primary or secondary to pulmonary tuberculosis. Nasopharyngeal tuberculosis may be mistaken for nasopharyngeal carcinoma as both conditions may present with a nasopharyngeal mass and cervical lymph node enlargement. We present a case of nasopharyngeal tuberculosis secondary to pulmonary tuberculosis who presented without any nasal or respiratory symptoms. The patient presented with a cervical lymph node enlargement and a nasopharyngeal mass was detected on nasal endoscopy. Fine needle cytology from the cervical node and the initial biopsy report from the nasopharyngeal mass were not confirmatory, causing a diagnostic dilemma. A repeat biopsy from the nasopharyngeal mass with the demonstration of caseating granuloma and acid-fast bacilli in the specimen pointed to the diagnosis of nasopharyngeal tuberculosis. The patient responded well to the standard 6-month anti-tubercular regimen. Nasopharyngeal tuberculosis may mimic nasopharyngeal carcinoma and a repeat biopsy may be necessary to confirm the diagnosis.
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For cervical lymph nodes, clinical insights often point to neck swelling, and frequently, the diagnosis can be made using fine needle aspiration and cytology exams.
“For the most common site for TB in the head and neck region, the cervical lymph nodes, clinical insights often point to neck swelling, and frequently, the diagnosis can be made using fine needle aspiration and cytology exams [29,30].”
From Head and Neck Tuberculosis: A Rare Diagnosis and the Role of Surgical Biopsy and Histopathological Evaluation in Extrapulmonary Disease (2025) · cites this paper as [30]
The Discussion (page unavailable) says cervical tubercular lymphadenitis accounts for most head-and-neck tuberculosis, and the Case report describes presentation with a neck lump. But the paper does not say diagnosis is frequently made by fine-needle aspiration cytology; in its case, that test was inconclusive and a repeat biopsy was needed. (LLM, conf=0.88)
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- Authors
- Penjor, D., & Pradhan, B.
- Affiliations
- Khesar Gyalpo University of Medical Sciences of Bhutan (BT)
- Department of Pathology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
- Corresponding author
- Penjor, Dorji
- Venue
- SAGE Open Medical Case Reports
- Publisher
- SAGE Publications
- Published
- 2022-01
- Volume
- 10
- Pages
- 2050313X221131389-2050313X221131389
- ISSN
- 2050-313X (ISSN-L)
- PMC
- PMC9577071
- OpenAlex
- W4307036866
- Cited by
- 7
- References
- 19
- Citations by year
- 2025: 4 · 2024: 1 · 2023: 2
- FWCI
- 1.67
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- SAGE Open Medical Case Reports (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Surgery › Diagnosis and treatment of tuberculosis
- Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
- Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
- Keywords
- nasopharyngeal tuberculosis, extrapulmonary tuberculosis, pulmonary tuberculosis, diagnostic challenges, cervical lymphadenopathy, nasopharyngeal mass, fine needle aspiration cytology, repeat biopsy, caseating granulomas, acid-fast bacilli, tuberculosis treatment
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