Primitive Cavum Tuberculosis: An Unusual Location of Mycobacteria

Abstract

<i>Objective:</i> This is a 17-year-old patient with no known history who had consulted the ENT department of the CHU-Gabriel Touré for persistent obstruction of the right nose. Its clinical history dates back to approximately 03 years, marked by a unilateral right nasal obstruction of progressive installation and permanent evolution associated with purulent posterior rhinorrhea, anosmia, right hypoacusis, headaches in helmet and an alteration of the state. general. There was no notion of cough, evening fever or epistaxis. These symptoms motivated several unspecified treatments without improvement. Before the onset of ptosis and ipsilateral blindness, he consulted us for support. We noted on otoscopy a dull right eardrum with a hearing loss of 25 decibels (db). Ophthalmological examination showed ptosis, ophthalmoplegia and blindness on the right side. Nasofibroscopy revealed a budding lesion taking up the entire right half of the roof of the nasopharynx filling the Rosenmüller fossa. There was no palpable cervical adenopathy. HIV serology was negative. Maxillofacial computed tomography revealed a rectilinear nasal sinus osteolytic expansive tumoral process extending to the optic nerve as well as to the oculomotor muscles with grade II proptosis (figure 1). Two repeated biopsies of the lesion found tuberculosis in front of a gigantocellular epithelioid granuloma with caseous necrosis. Intradermal tuberculin reaction and AFB sputum became negative. The chest X-ray was normal. We carried out the surgical excision of the lesion and the diagnosis of tuberculosis was confirmed by the anatomopathological examination. The patient was placed under anti-tuberculosis verification according to the 2RHZE / 4RH Protocol. The evolution was favorable after two months with normalization of the signs on nasofibroscopy.