A 45 years old patient, chronic smoker, presented with unilateral lymphadenopathy gradually increasing in size with weight loss, associated with nasal obstruction and hearing loss of the right ear. Clinical examination found a painless firm lymphadenopathy of the right jugular era measuring 3cm and a secretory otitis media. The endoscopy found a tumor in the right posterolateral wall of the nasopharynx. CT scan showed a mass in the posterior wall of the nasopharynx with retropharyngeal lymphadenopathies. A biopsy was performed.
In four cases, histopathological study showed nasopharyngitis and granulomas with histiocytic, epithelioid, and giant multinucleated Langhans cells as well as caseous necrosis (Figure 4). Further examinations searching for other locations were negative confirming the diagnosis of primary nasopharyngeal tuberculosis. All patients received anti bacillary treatment based on rifampicin 10mg/kg/day, isoniazid 5mg/kg/day, pyrazinamide 20mg/kg/day during 2 months followed by rifampicin and isoniazid during 4 months. A clinical, endoscopic and histological surveillance was implemented and the evolution was favorable in all cases.