Primary tuberculosis of frontal sinus presenting as intractable headache

Abstract

Aim: Headache with sinonasal polyps not responding to routine medical and surgical management is a real challenge to a rhi-nologist. Here we present a rare case of primary tuberculosis (TB) of frontal sinus presenting as intractable headache. Background: Pulmonary TB is common in developing countries like India. With the advent of effective treatment, the incidence of otorhinolaryngological TB has come down significantly. Otorhinolaryngological TB constitutes <5% of all cases of extrapulmonary tuberculosis (EPTB). In ear, nose, and throat (ENT), TB of cervical lymph nodes is common in low socioeconomic groups. Most of the ENT TB is secondary to pulmonary infection. Tuberculosis of paranasal sinuses is a rare thing to occur and primary affection of it is still a rarity. Among paranasal sinuses, maxillary sinus is the most frequently involved sinus and is usually unilateral. Case report: A 35-year-old, diabetic female presented with severe headache, forehead swelling, and nasal blockage. Nasal endoscopy revealed multiple nasal polyps with anterior table of frontal sinus eroded on computed tomography (CT) scan. The patient underwent endoscopic sinus surgery. Histopathological examination (HPE) of sinonasal tissue was suggestive of inflammatory polyps. Her headache persisted and nasal polyps recurred in less than 2 months. On second endoscopic surgery, Draf 2 was done. There was no improvement in headache; HPE suggested granulomatous disease; all other reports of TB were negative, so the patient was put on antituberculosis treatment (ATT). After 1 month of treatment, her headache was relieved, with no recurrence of polyps. Conclusion: Primary TB of frontal sinus, though rare, can be the cause of headache, and high index of suspicion is the only way to treat it. Moreover, ATT is sufficient to treat and invasive procedures can be avoided. Clinical significance: Tuberculosis of frontal sinus should be kept in mind in the era of human immunodeficiency virus (HIV) and immunocompromised patients.