Primary tuberculosis of the pyriform sinus: A case report

INTRODUCTION: Tuberculosis is a chronic bacterial infection caused by the Mycobacterium tuberculosis. Extrapulmonary tuberculosis (EPTB) accounts for about 20% of cases in immunocompetent patients and 50% of cases in HIV-positive individuals (7). Except for the cervical lymph nodes location, head and neck tuberculosis is rare. CLINICAL PRESENTATION: A 32-year-old man presented with chronic and progressive sore throat and dysphagia lasting for 4 months. The clinical examination revealed a lesion in the left piriform sinus confirmed by CT. a biopsy was performed and the histological results showed a chronic and granulomatous inflammatory process composed of epithelioid and giganto-cellular follicles centered by large areas of caseous necrosis, concluding tuberculosis of the pyriform sinus. DISCUSSION: Primary tuberculosis of the hypopharynx is very rare. In most cases, is revealed by odynophagia, dysphagia, but it can also mimic the signs of a malignant tumor, hence, the difficulty in diagnosing this localization. Few articles have been reporting cases of hypopharyngeal tuberculosis, in these articles, the main symptom was dysphagia, as was the case with our patient. Given the rarity of hypopharyngeal tuberculosis, several differential diagnoses are to consider: squamous cell carcinoma, which is has a similar clinical manifestation to tuberculosis. There is also, rarely, oropharyngeal lymphoma, minor salivary gland tumors, neurogenic tumors, and Wegener's disease. The Diagnosis of EPT is established when Mycobacterium tuberculosis bacillus is isolated and the epithelioid and giganto-cellular follicles centered by large areas of caseous necrosis is found in the histopathological examination of the endoscopic biopsy specimen. The Treatment is medical, by Anti bacillar chemotherapy, however the period is longer the pulmonary tuberculosis, it extends from of six to twelve months. Through this study, the main lesseons and are that Malignant lesion is always to rule out when a suspicious lesion of the hypopharynx is found, we also come to conclude that the ndoscopic and clinical aspect between tumoral and tuberculosis of the hypopharynx are very similar The diagnosis is confirmed with biopsy of the lesion. CONCLUSION: primary tuberculosis of the pyriform sinus is very rare. it's mandatory to rule out malignant pharyngeal lesions and consider hypo-pharyngeal tuberculosis as one of the differential diagnoses in lesions especially in the countries where tuberculosis is endemic.