TB of Maxillary Sinus

Case 7: TB of Maxillary Sinus (Nasal Cholesteatoma)

A 28 year old male was seen with complaints of left-sided nasal obstruction and left-sided proptosis and restriction of extra ocular eye movements (See Figure 1). The X-ray showed right-sided upper and mid-zones collapse-consolidation with right hilar lymphadenopathy and ESR showed significant rise in the count (See Figure 2).

Figure 1: Frontal View of Patient with Proptosis of Left Eye
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Figure 2: Chest X-Ray
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A CT scan of his paranasal sinuses showed an enhancing soft-tissue density/mass involving the extraconal and intraconal compartments of the left orbit with extension into the left ethmoid sinuses and destruction of the lamina papyracea (Figure 3).

In order to take an adequate size specimen for biopsy, The endoscopic approach was chosen. Diagnostic nasal endoscopy showed a whitish doughy mass occupying the left middle turbinate. The maxillary sinus showed white caseous material with lot of inflammatory tissue. There was erosion of the superior border of the maxillary sinus and the eyeball protruded into the maxillary sinus on applying external pressure.

Figure 3: Axial CT Scan
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Figure 4: Post Operative Appearance of the
Patient With Nasal Tubes
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The histopathology report showed granulomatous lesions with central caseous necrosis surrounded by epitheloid cells, plasma cells and also presence of langhans giant cells and reported it as tuberculosis.

Patient was diagnosed as ‘Extrapulmonary tuberculosis (seriously ill)’ by internal medicine physician and was enrolled under category I (CAT I) anti Koch’s treatment (AKT) regimen under ‘Revised National Tuberculosis control Programme’ (RNTCP) with isoniazid 600mg, rifampicin 450 mg, pyrazinamide 1500 mg, ethambutol 1200 mg thrice weekly for 6 months and was followed up for 6 months. Thereafter he received another extended 2 months of AKT as per physician’s advice.
(See Figure 4 - Above)