CRA45 THE NASOPHARYNGEAL PUZZLE: UNCOVERING PRIMARY TUBERCULOSIS IN AN UNLIKELY SITE

Teegeena Jeeva Kumar; Arvindran Alaga; Noor Idayu Ibrahim; Nor Rahimah Aini

1.Medical Department Hospital Sultanah Maliha
2.Respiratory Department, Hospital Sultanah Bahiyah
3.Histopathology Department Hospital Sultanah Bahiyah
4.Ear, Nose and Throat Department Hospital Sultanah Maliha

INTRODUCTION
Nasopharyngeal tuberculosis (NPTB) is an exceptionally rare form of extrapulmonary tuberculosis, accounting for less than 1% of all TB cases. Due to its nonspecific and variable clinical presentation, it is often overlooked and may mimic other head and neck pathologies, especially malignancies.

OBJECTIVES
To present a rare case of nasopharyngeal tuberculosis

CASE PRESENTATION
A 32-year-old woman presented with a chronic, non-productive cough, intermittent fever, and significant weight loss. She also reported bilateral neck swelling. Clinical examination revealed firm cervical lymphadenopathy: a 2 × 1 cm node on the right and a 1 × 1 cm node on the left. Initial tuberculosis screening at a community clinic was negative. She was subsequently referred to the ENT clinic, where flexible nasopharyngoscopy revealed irregularly enlarged adenoids. Fine needle aspiration of the cervical lymph nodes and a biopsy of the nasopharyngeal lesion were performed. Histopathological examination of both specimens confirmed caseating granulomatous inflammation, consistent with tuberculosis. The patient was initiated on standard anti-tubercular therapy for nine months and demonstrated significant clinical improvement.

DISCUSSION & CONCLUSION
Nasopharyngeal tuberculosis remains an exceedingly rare and often underdiagnosed entity, with fewer than 50 cases reported worldwide. Its clinical presentation can be misleading, as seen in this patient whose main symptoms were chronic cough and cervical lymphadenopathy, with initial TB investigations yielding negative results. This case highlights the importance of histopathological examination in atypical cases and advocates for a low threshold of suspicion for nasopharyngeal TB.