Implications of the Increased Prevalence of Tuberculosis Infections for Current Ear, Nose, Throat Practice: Be Alert, Not Alarmed

Background and Aim: Although the improvement in socioeconomic conditions and the use of effective antibiotic therapy have caused a decline in the prevalence of tuberculosis in western countries for several decades, 9 million new cases per year appear worldwide. That in turn has caused serious concerns for medical authorities regarding the potential outbreak of tuberculosis incidences in developed countries, as a result of the increased emigrational trends. The aim of this study is to report a case of granulomatous infection of the adenoids, which was initially considered TBC due to this enhanced alert. Case Report: A 16-year old male adolescent presented to the outpatient department because of nasal obstruction, cough, anorexia, and chronic fatigue for the past 12 months. The patient examination was unremarkable, apart from hyperplastic adenoid tissue on flexible endoscopy. Blood tests and chest x-rays were also normal. The patient underwent adenoidectomy and the specimens were sent for biopsy. Pathology reported necrotic areas of tyromatosis, a finding consistent with tuberculosis infection. Subsequent pneumonologic evaluation was, however, normal; the Mantoux skin reaction was negative; and a chest CT also proved normal. A PCR analysis for Mycobacterium was also negative. Despite the fact that only a few cases of isolated tuberculosis of the adenoids are reported in the literature, the patient remained under observation due to the persistence of fatigue and anorexia, but not to be treated for tuberculosis. Conclusion: The reported increase in the prevalence of TBC and the fact that the latter can mimic a number of pathological conditions dictate a high degree of suspicion for the occurrence of this disease in ENT patients. However, a cautious approach is warranted because other underlying pathologies might exist in ambiguous cases.