A 29-year-old male patient presented with a sore throat, nasal congestion, dysphagia, and low-grade fever for 2 months, with a temperature of up to 37.6 C. He denied a history of organ diseases such as diabetes, kidney disease, liver disease, tuberculosis infection, long-term use of hormones, immunosuppressants, and a family history of tuberculosis infection. Physical examination showed poor ventilation of the nasal cavity bilaterally, with hypertrophy and swelling of the nasal mucosa, purulent secretions, and multiple enlarged lymph nodes with clear borders, the larger one being about 2 cm x 3 cm, were palpated in the neck bilaterally. We took the secretion for culture and identification, which showed no pathogenic bacteria growth in bacterial culture and white pseudomycetes in fungal culture. In addition, nasopharyngoscopy showed thickened mucosa in the posterior wall of the nasopharynx, covered with a thick yellowish purulent secretion that was not easily removed (Figure 1). Computed tomography of the nasopharynx showed mucosal thickening on the left and right sides of the wall and posterior wall with indistinct margins and multiple enlarged lymph nodes in the retropharyngeal space, left the palatine tonsillar area, and both sides of the neck (Figure 2a and b). Computed chest tomography displayed pulmonary tuberculosis in the upper lobe of the left lung and left-sided tuberculous pleurisy (Figure 2c and d). Ultrasonography of cervical lymph nodes demonstrates multiple enlarged solid hypoechoic lymph nodes with well-defined borders, the largest on the right side measuring approximately 3.3 cm x 1.9 cm and the larger one on the left side measuring approximately 2.7 cm x 1.4 cm, with a few lymph nodes showing mildly increased vascularity and partial liquefaction (Figure 3a and b). Antacid bacilli can be found by taking sputum from patients for antacid bacillus smear examination. Moreover, we also performed a T-cell test for tuberculosis infection, whose result was positive. The above-mentioned tests suggested the possibility of nasopharyngeal tuberculosis in this patient, but a definitive diagnosis still required histopathological examination. Therefore, a nasopharynx extraction biopsy was performed using a 0  rigid nasal endoscope under local anesthesia. Postoperatively, the specimen was stained with hematoxylin-eosin, and epithelioid reaction (Figure 4a) was found under microscopic magnification of 100x, and multinucleated giant cells (Figure 4b) were observed under magnification of 40x, suggesting nasopharyngeal tuberculosis granuloma. Therefore, the patient was finally diagnosed with nasopharyngeal tuberculosis granuloma and tested for Mycobacterium tuberculosis rifampin resistance by sputum, which showed that the rifampin resistance mutation gene rpoB was sensitive. Furthermore, the Mycobacterium tuberculosis gene probe A-E (representing 81 bases in the RRDR region of the tuberculosis rpoB gene and 5 different DNA fragments) was positive, and the patient was given HRZE (isoniazid 300 mg, rifampin 450 mg, pyrazinamide 1,500 mg, ethambutol 750 mg) anti-tuberculosis treatment. After 1 month of antituberculosis treatment, the patient's sore throat, nasal congestion, and dysphagia disappeared.