Primary Sinonasal Tuberculosis Mimicking Nasal Polyps: A Diagnostic Challenge and Management Approach, Case report

Introduction: Primary sinonasal tuberculosis is an extremely rare form of extrapulmonary tuberculosis, often misdiagnosed due to its nonspecific clinical presentation that mimics other sinonasal conditions, such as chronic rhinosinusitis or nasal polyps. We present a case of primary sinonasal tuberculosis in a patient with persistent nasal obstruction and rhinorrhea, initially diagnosed as chronic rhinosinusitis.
Case Report: A 34-year-old female presented with a 5-month history of nasal obstruction and rhinorrhea, later complicated by anosmia. Initial clinical examination revealed bilateral nasal polyps, while imaging demonstrated extensive sinonasal involvement, including maxillary sinus obliteration and bony erosion. Biopsy results showed granulomatous inflammation, and GeneXpert PCR confirmed Mycobacterium tuberculosis, leading to the final diagnosis of primary sinonasal tuberculosis. The patient underwent endonasal endoscopic surgery to excise the mass, followed by a standard 6-month regimen of antitubercular therapy.
Discussion: Sinonasal tuberculosis presents a significant diagnostic challenge, often mimicking other chronic nasal conditions. Histopathological findings, including granulomatous inflammation, are essential for diagnosis, while GeneXpert PCR offers rapid and accurate confirmation. Treatment involves a combination of medical therapy and surgical intervention, particularly in cases with extensive sinus involvement.
Conclusion: Primary sinonasal tuberculosis, though rare, should be considered in the differential diagnosis of chronic sinonasal conditions, particularly in patients who fail to respond to standard treatments. Early diagnosis and treatment with antitubercular therapy and surgical excision can lead to favorable outcomes and prevent complications.