gms | German Medical Science

We report the rare case of a paranasal sinus tuberculosis causing meningitis. The patient presented with right sided headache and epiphora. The cranial MRI and the CT scans of the paranasal sinuses showed an affection of the meninges due to a sinusitis. The patient already had undergone functional endoscopic sinus surgery due to chronic rhinosinusitis with polyps years ago. He also had a history of pulmonal tuberculosis during childhood. The endoscopic examination showed a recurrent rhinosinusitis with polyps. The chest x-ray showed no signs for residual or acute pulmonal affection due to tuberculosis. We performed a computer assisted endoscopic sinus surgery. Histological and molecular investigations confirmed mycobacterial infection of the paranasal sinuses. Therefore a conventional treatment with a combination of four antituberculostatica was initiated for one year.

To summarize, infections due to mycobacterium tuberculosis of the head and neck region mainly affect the cervical lymph nodes. An infection of the nose or the paranasal sinuses is rare. Nevertheless one should keep in mind tuberculosis as a differential diagnosis of acute or chronic rhinosinusitis. Mostly, the correct diagnose is only possible using histopathological and microbiological methods.