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Anales de Otorrinolaringología Mexicana

2012, Number 4

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Otorrinolaringología 2012; 57 (4)

Tuberculosis and Wegener’s granulomatosis in otorhinolaryngology

Morales CGM, Morales RLI, Tapia ÁL, Zubiaur GF, Martínez GF

Language: Spanish
References: 30
Page: 236-245
PDF size: 286.49 Kb.


ABSTRACT

Tuberculosis is caused by Mycobacterium tuberculosis. It affects to nine million persons around the world, and two to three million of them die because of it. It has been noticed a greater incidence since the appearance of HIV, because it increases 500 times the risk for tuberculosis. Laboratory tests should be done to determine the diagnosis such as AFB staining, cultures, HIV and PCR. Tuberculosis of the head and neck accounts for 10% to 35% of all tuberculosis. The main place of presentation is the lymphatic nodes (96%), mainly at the posterior triangle; followed by the larynx (1%), pharynx, tonsils, nasal cavity, ear, paranasal sinus, mastoid and salivary glands. Most cases of extrapulmonary tuberculosis are secondary to a pulmonary infection and spreads by direct extension or blood. Wegener’s granulomatosis is a vasculitis of small and medium sized vessels associated to neutrophil cytoplasmic antibodies (ANCA). It has a classic triad of necrotizing granulomatous lesions in the upper and lower airways, vasculitis and glomerulonephritis with focal necrotizing granulomatosis, capillary thrombosis and necrosis. In some cases it is impossible to differentiate tuberculosis and Wegener’s granulomatosis since both produce necrotizing lesions in the lungs. This paper presents a case report of a 40-year-old female, without personal or pathological history, who suffered an episode of rhinosinusitis and otitis media, with yellowish discharge of the left ear, hearing loss, othalgia, and a tympanic perforation; latter on, low pitch hoarseness. She received treatment with systemic steroids and antibiotics, but she didn’t respond positively. A direct laryngoscopy was done and a biopsy was taken from the subglottic lesion, which was positive to Mycobacterium tuberculosis with auramine rhodamine. An antifimic treatment was prescribed; however, the patient suffered a left facial paralysis and, a month later, an episode of rhinosinusitis and granulomatous lesion at the right parotid level. Despite antituberculous therapy, four months later she showed cavitary lesions in lung; pulmonary segmentectomy not anatomic was performed. Histopathological study showed Wegener’s granulomatosis. This case represents the association between extrapulmonary tuberculosis and Wegener’s granulomatosis.


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