原发性鼻咽结核误诊1例并文献复习

Misdiagnosis of primary nasopharyngeal tuberculosis:a case report and literature review

目的通过研究原发性鼻咽结核(primary nasopharyngeal tuberculosis,PNT)的临床特点及误诊的原因,为耳鼻喉科医生提供临床借鉴和参考。方法回顾性分析PNT误诊1例,并结合相关文献,分析其临床特点及易被误诊的原因。结果PNT临床表现与鼻咽部病变的增生程度有关,通常无结核病相关临床表现,不易与慢性鼻咽炎鉴别;病理检查诊断结核不够明确时,需行结核相关检查,并嘱咐患者密切随访;在治疗方面,仍以全身性的抗结核治疗为主。结论PNT较罕见,且缺乏典型的临床表现,易被误诊为慢性鼻咽炎。组织病理结合结核相关检查有助于提高诊断率,同时定期复诊也是避免误诊的一个重要因素。

Objective This study aimed to provide a clinical reference for otolaryngologists by identifying the clinical characteristics of nasopharyngeal tuberculosis and causes of misdiagnosis.Methods This retrospective analysis included data of one case of misdiagnosis of primary nasopharyngeal tuberculosis(PNT).We analyzed the clinical characteristics of the case and reasons why it was easily misdiagnosed,considering the relevant literature.Results The clinical manifestations of PNT were related to the degree of hyperplasia of the nasopharyngeal lesions,which usually do not have clinical tuberculosis-related manifestations and cannot easily be distinguished from chronic nasopharyngitis.In cases wherein tuberculosis diagnosis is not clear enough based on pathological examination,tuberculosis-related tests should be performed and patients should be instructed to adhere to close follow-up.Regarding treatment,systemic anti-tuberculosis agents are still the mainstay of therapy.Conclusion PNT is relatively rare and lacks typical clinical manifestations,making it be easily misdiagnosed.Histopathology combined with tuberculosis-related tests could help improve diagnosis of PNT.Furthermore,regularly close follow-up is also an important key factor in avoiding misdiagnosis.