Abstract
Paranasal tuberculosis is a rare disease and only 26 cases have been reported in the Japanese literature. We describe a case of secondary maxillary tuberculosis.
The patient was a 72 year-old female who complained of right nasal discharge and bloody sputum. A CT-scan showed that the right maxillary sinus was diffusely cloudy and had the legion with enhancement effect. The patient had been hospitalized previously for treatment of pulmonary tuberculosis 50 years ago. However there has been no evidence of recrudescence since then. Open biopsy of the maxillary sinus was performed and rapid histopathological examination did not reveal a malignant tumor, Caldwell-Luc surgery, in addition to ethmoidectomy and sphenoidostomy were performed successively. The mucous membrane of the maxillary sinus had some polypoidly thickened lesion and a grayish lesion. The mucous membrane and content of the maxillary sinus were examined by Ziehl-Neelsen's staining and no acid fast bacilli were identified. The diagnosis was made on the basis of histopathological findings which revealed some epithelomd cells under the mucosal epithelium and Langhans giant cells. Detection of Mycobacterium tuberculosis using PCR methods revealed sputum to be negative and the nasal discharge to be positive. We recognized that she did not harbour M. tuberculosis now, but that chemotherapy was necessary. After the operation, isoniazid, ethambutol and rifampicin were administered. Detection of M. tuberculosis using PCR methods was performed 40 days later and the nasal discharge was negative. No recurrence has been noted since she was released from the hospital. Hence PCR methods was able to detect M. tuberculosis rapidly and precisely, it was useful in determining the therapeutic plan and judging therapeutic effects.
