title: Primary nasopharyngeal tuberculosis: a case report.
abstract: BACKGROUND
  The occurrence of nasopharyngeal tuberculosis is rare even in areas where tuberculosis is endemic. Here, we report a case of rare primary nasopharyngeal tuberculosis, promptly evaluated by nasolaryngoscopy.
  
  
  METHODS
  A 78-year-old woman presented with postnasal drip and a cough of 1-month duration. Endoscopic examination of the nasopharynx revealed irregular mucosal thickening of the right lateral and posterior wall of the naso (epi)-pharynx, which was covered with yellow discharge presenting as postnasal drip. Computed tomography (CT) demonstrated enhanced soft tissue area in the right lateral and posterior wall of the nasopharynx. Bacteriological examination from a nasopharyngeal swab revealed that staining for acid-fast bacilli was positive and the quenching probe PCR test was positive for Mycobacterium tuberculosis. Histopathological examination from the thickening nasopharyngeal mucosa revealed granulomatous formation with caseous necrosis. Ziehl-Nielsen staining directly could detect acid-fast bacilli. Chest X-ray and CT scan ruled out the pulmonary tuberculosis. Base on these findings, we diagnosed it as primary nasopharyngeal tuberculosis. After six months anti-tuberculous therapy, the patient's symptoms had completely disappeared. Nasolaryngoscopic examination and CT image after 6 months post therapy revealed a normal nasopharynx with complete resolution of the lesion.
  
  
  CONCLUSIONS
  We recommend endoscopic examination for patients suffering from chronic postnasal drips to avoid inappropriate diagnosis.
authors.affiliation: Department of Otolaryngology, Yoshida General Hospital, Hiroshima, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Nakao
authors.affiliation: Department of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan. rshibata@med.nagoya-u.ac.jp.|Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan. rshibata@med.nagoya-u.ac.jp.
authors.forename: Rei
authors.initials: R
authors.lastname: Shibata
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
authors.affiliation: Department of Otorhinolaryngology, Aichi Medical University, Nagakute, Aichi, 480-1195, Japan. tanigawa@aichi-med-u.ac.jp.
authors.forename: Tohru
authors.initials: T
authors.lastname: Tanigawa
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D009297:Nasal Mucosa / Q000382:microbiology; D009302:Nasopharyngeal Diseases / Q000175:diagnosis* / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014376:Tuberculosis / Q000175:diagnosis* / Q000473:pathology
keywords: Nasolaryngoscopy; Nasopharyngeal; Postnasal drips; Tuberculosis