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Title : A 57 year-old female w/ nasal deformity
Date : January 9,2009
Contributed by

Soo-Youn Moon.M.D, Hae Suk Cheong,M.D. Samsung Medical Center, Seoul, Korea

Patient History
Age/Sex A 57 year old women
Chief complaint Nasal deformity
Present illness

She had been treated for abscess of nasal cavity 15 years ago and managed with antibiotics intermittently without improvement.Since that time, her nose has become deformed.

Physical examination

Defect of cartilaginous part of external nose and destroyed nasal septum with discharge (upper figure) and ulceration on hard palate. Initial vital sign : 110/70-80-20-36.2

Initial laboratory findings

Laboratoty test were all within normal limits.

Radiologic findings

Chest X-ray showed no abnormal findings. CT scan of head and neck showed defect of external nose and anterior cartilaginous nasal septum.

Hospital course

Biopsy was done from ulcerative lesion of nasal septum (bottom figure).

Figure

 
Question - ID Case of the Week ( January 9,2009 )
What is your diagnosis?
 
Correct Answer

Tuberculosis chondritis

 
Review

 # Nasal tuberculosis chondritis

 Nasal TB chondritis is quite rare.
  • Predominantly found among females and usually in  the elderly
  • Commonly affected site – cartilaginous septum and  the inferior turbinates
  • Symptoms
Common: nasal obstruction and nasal discharge
Less common: nasal discomfort or a mass, epistaxis, crusting, watering of the eyes, postnasal drip, recurrent polyps, and a nasal ulcer
  •Possible routes of infection
Secondary infection from pulmonary TB with the

    infection spreading by contagious, hematogenous or  lymphatic routes.

Dust or sneezing droplets from infected persons
Direct inoculation by contaminated fingers

  Diagnosis
           
High index of suspicion
           
The radiological investigation is helpful when TB of the head and  
               neck  is suspected.

            
Histopathological
examination is required.
           
Isolation of M. tuberculosis from the tissue culture: definitive diagnosis.
           
Positive AFB staining or a positive TB PCR of infected tissue:
               alternative diagnostic methods
 
 
Treatment
           
Conservative therapy with tuberculosis medications
           
Duration : usually 6- 12 months


 
 


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