Table of Contents  
LETTER TO THE EDITOR
Year : 2014  |  Volume : 7  |  Issue : 4  |  Page : 533-534  

Comments on "Primary nasal tuberculosis following blunt trauma nose"


Department of Otorhinolaryngology, Kawdoor Sadananda Hegde Medical Academy, Mangalore, Karnataka, India

Date of Web Publication25-Jun-2014

Correspondence Address:
Vadisha Bhat
Department of Otorhinolaryngology, Kawdoor Sadananda Hegde Medical Academy, Mangalore - 575 018, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.135302

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How to cite this article:
Bhat V. Comments on "Primary nasal tuberculosis following blunt trauma nose". Med J DY Patil Univ 2014;7:533-4

How to cite this URL:
Bhat V. Comments on "Primary nasal tuberculosis following blunt trauma nose". Med J DY Patil Univ [serial online] 2014 [cited 2021 Sep 17];7:533-4. Available from: https://www.mjdrdypu.org/text.asp?2014/7/4/533/135302

Sir,

I read the case report on "Primary nasal tuberculosis following blunt trauma nose" with interest. [1] The authors' work needs appreciation about the work-up of the reported patient. Nasal tuberculosis is extremely rare even in a country like India, where pulmonary tuberculosis is rampant, especially in immunocompromised patients. It is worth noting that the patient in the report is immunocompetent. It is amazing that the bacilli that pass through the nasal cavity to reach the lung causing pulmonary tuberculosis rarely harms the nasal cavity. However, the inoculation of the bacilli is possible, when there is a trauma to the nasal mucosa, [2] which is probably the cause in this report. A mention of the history of exposure to active tuberculosis cases would make the report more appropriate in establishing the role of trauma due to nasal pack as a cause of tuberculosis. The presentation of the case approximately 4 months after this trauma would also make one think that flaring up of an existing small lesion after trauma, as the computed tomography scan of the case shows quite an extensive lesion. Although the presence of caseating granuloma is confirmatory of tuberculosis, the caseation is not seen in all cases of extrapulmonary tuberculosis. When the biopsy specimen does not show caseation or show Acid fast bacilli on staining, polymerase chain reaction (PCR) is a useful tool for confirmation. [3],[4] PCR for detecting the mycobacterial DNA is a rapid, sensitive as well as specific test for the diagnosis of Mycobacterium tuberculosis. The test can be performed in fresh tissue as well as in formalin-fixed specimens. [5],[6] Although a culture of mycobacterium is more specific, it requires 10-100 bacilli/mL of sample for diagnostic yield. [5] The association of tuberculosis with malignancy warrants thorough histopathological examination of the tissue by extensive sampling. [3],[4] The management part is meticulously dealt with by the authors.

In conclusion, primary nasal tuberculosis is a rare entity, but should be a differential diagnosis in a nasal mass. Otolaryngologists should be aware of this condition, which can be treated effectively with anti-tuberculosis medication. PCR for M. tuberculosis, whenever possible, would confirm the diagnosis authentically.

 
  References Top

1.Saha K, Mitra M, Saha A, Barma P. Primary nasal tuberculosis following blunt trauma nose. Med JDY Patil Univ 2014;7:50-2.  Back to cited text no. 1
    
2.Kameswaran M, Ananda Kumar RS, Murali S, Raghunandan S, Vijaya Krishnan P. Primary nasal tuberculosis: A case report.Indian J Otolaryngol Head Neck Surg 2007;59:87-9.  Back to cited text no. 2
    
3.Bhat VS, Bhandary SK,Shenoy MS, Bk SC, Bs G. A rare case of lupus carcinoma of external nose. Indian J Surg Oncol 2011;2:215-7.  Back to cited text no. 3
    
4.Masterson L, Srouji I, Kent R, Bath AP. Nasal tuberculosis -an update of current clinical and laboratory investigation. J Laryngol Otol 2011;125:210-3.  Back to cited text no. 4
    
5.Chawla K, Gupta S, Mukhopadhyay C, Rao PS, Bhat SS. PCR for M. tuberculosis in tissue samples. J Infect Dev Ctries 2009;3:83-7.  Back to cited text no. 5
    
6.Salian NV, Rish JA, Eisenach KD, Cave MD, Bates JH. Polymerase chain reaction to detectmycobacterium tuberculosisin histologic specimens.Am J Respir Crit Care Med 1998;158:1150-5.  Back to cited text no. 6
    




 

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