以雙側中耳積水表現之原發性鼻咽結核－病例報告

Primary Nasopharyngeal Tuberculosis Initially Presenting as Bilateral Otitis Media with Effusion-Case Report

黎子瑜(Tzu-Yu Li) ； 羅武嘉(Wu-Chia Lo) ； 鄭博文(Po-Wen Cheng)

《台灣耳鼻喉頭頸外科雜誌》 54卷3期 (2019/09) Pp. 168-171

https://doi.org/10.6286/jtohns.201909_54(3).168

摘要

結核病為全世界常見的感染症。臺灣為結核病盛行地區。肺外結核中，原發於鼻咽的結核病是非常罕見的。上呼吸道結核約佔結核病的1.8％而其中鼻咽部又更為少見，約占0.1％。鼻咽結核治療方法依照臺灣結核病治療指引。本篇報告一罕見鼻咽結核併雙側慢性中耳積水，初始臨床表現為膿狀鼻涕倒流伴隨聽力損失，經由21天抗生素治療仍無改善。由鼻咽内視鏡及頭部電腦斷層懷疑鼻咽部病變。經兩次病理切片報告為壞死及慢性發炎組織，最終由培養出結核菌確診，轉由感染科後續治療。結核菌又被稱為偉大的模仿者，其症狀常容易與其他疾病混淆，臨床外觀表現從發炎反應到外觀類似腫瘤的惡性表徵都可能為其表現。在臺灣若臨床表現為鼻咽部病灶及雙側中耳積水，除需排除鼻咽癌外仍需將結核病列入鑑别診斷。由於此病例極為少見，臨床上難以立即做出診斷，藉此病例與大家分享。

關鍵字

nasopharynx ； tuberculosis ； otitis media with effusion（鼻咽部 ； 結核病 ； 中耳積水）

並列摘要

Tuberculosis (TB) is a common infectious disease worldwide. TB has a high incidence in Taiwan. Primary nasopharyngeal tuberculosis is an exceedingly rare disease entity. The rate of TB infection in upper respiratory tract is about 1.8% and involvement rate of nasopharynx is about 0.1%. The treatment of TB is according to Taiwan treatment guidelines. We encountered a very rare case of primary nasopharyngeal TB presenting as bilateral otitis media with effusion. At first, she was unsuccessfully treated as acute paranasal sinusitis. Although nasopharyngoscopy and head computed tomography revealed nasopharyngeal mass, pathologies of biopsy specimens taken twice revealed necrosis and chronic inflammation only. After referral to our clinic, the definite diagnosis of nasopharyngeal TB was made due to positive result of TB culture. TB is notorious as the great mimicker because its clinical symptoms are often similar to those of other infection diseases, inflammatory disorders or even malignancy. In epidemic regions, patients with nasopharyngeal mass and bilateral middle ear effusion, the possibility of TB infection should be keep in mind in addition to nasopharyngeal carcinoma. To our knowledge, this is the first case report in the literature.

並列關鍵字

nasopharynx ； tuberculosis ； otitis media with effusion