Abstract
<title>Abstract</title> <p>Background Primary nasal tuberculosis is an exceedingly rare manifestation of extrapulmonary tuberculosis. Because of its nonspecific clinical presentation, it is frequently misdiagnosed as inflammatory, infectious, or neoplastic disease. We report a case of primary nasal tuberculosis presenting as a unilateral nasal septal mass with associated mucosal lesions. Case Presentation A 33-year-old male patient presented with a history of progressive left-sided nasal obstruction of a six-month duration associated with a slowly enlarging painless nasal mass and intermittent epistaxis. Physical examination revealed a nodular mass originating from the caudal side of the nasal septum and multiple whitish plaque-like lesions in the nasal cavity and the nasopharyngeal mucosa. CT scan showed an isodense soft tissue mass in the left anterior nasal cavity without significant contrast enhancement or bony destruction. Histopathological examination of a punch biopsy showed epithelioid granulomas with central necrosis and multinucleated giant cells in a background of dense chronic inflammatory infiltrates. The sputum acid-fast bacilli smear was negative; however, GeneXpert testing detected Mycobacterium tuberculosis. Chest radiography revealed no evidence of pulmonary tuberculosis. These findings confirmed a diagnosis of primary nasal tuberculosis. He was treated with standard anti-tuberculosis therapy for 6 months and demonstrated complete clinical and endoscopy resolution of the disease after six months of treatment. Conclusion We should consider primary nasal tuberculosis in the differential diagnosis of unilateral nasal masses, particularly in tuberculosis-endemic regions. Histopathological examination and microbiological confirmation are crucial for diagnosis. Early initiation of anti-tuberculosis therapy results in excellent outcomes and minimizes unnecessary complications.</p>