Liu Yong-Cai, Zhou Min-Li, Cheng Ke-Jia, Zhou Shui-Hong, Wen Xue
Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, HangZhou 310003, Zhejiang Province, China.
Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China.
World J Clin Cases. 2024 Jun 16;12(17):3271-3276. doi: 10.12998/wjcc.v12.i17.3271.
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.
原发性鼻结核是肺外结核的一种罕见形式，尤其是在接受抗肿瘤坏死因子（TNF）免疫治疗的患者中。因此，其诊断仍然具有挑战性。
一名58岁男性患者因右侧鼻塞和血性分泌物1个月就诊于耳鼻喉科。他被诊断为银屑病关节炎，并在就诊前接受了3年的抗TNF免疫治疗。活检结果显示慢性肉芽肿性炎症和少量抗酸杆菌，提示原发性鼻结核。他被转诊至我们的结核病管理部门，接受口服抗结核药物治疗。9个月后，鼻部病变消失。随访期间未发现复发。
在接受TNF拮抗剂治疗且出现鼻中隔黏膜或下鼻甲增厚和结痂的患者中，应考虑原发性鼻结核的诊断，尤其是当病理结果提示肉芽肿性炎症时。
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