Primary Tuberculosis of pharynx-diagnostic difficulties, complications and treatment

Abstract

Primary tuberculosis of the upper respiratory tract is extremely rare and poses a diagnostic challenge. Due to delay in diagnosis the disease may progress to life threatening airway compromise. Here we report a case of chronic granulomatous infection of the upper respiratory tract involving the oropharynx. Initial biopsy revealed acute on chronic inflammation with no epitheloid granuloma and no acid fast bacilli was found on Ziehl-Nielsen staining of the biopsy. As a result of delay in diagnosis the disease progressed to involve the soft palate, valopharyngeal isthmus, and supraglottis compromising the airway and needed emergency tracheostomy. Where there is strong clinical suspicion repeat biopsy should be performed. The life threatening complication of pharyngeal tuberculosis such as stenosis and adhesion leading to airway compromise can occur during the course of treatment and should be closely monitored . It can be managed effectively with radiofrequency uvulopalatoplasty as demonstrated in the case report.