ŞERİFE SAVAŞ BOZBAŞ, Nevra Güllü ARSLAN, MÜŞERREF ŞULE AKÇAY, Nur ALTINÖRS

Frontal sinüs tutulumu ile seyreden tüberküloz olgusu

Akciğer dışı tüberküloz (TB) hiç de seyrek olmayan ve hemen her organı tutan bir hastalıktır. Nazal kavite ve paranazal sinüs tutulumu oldukça nadir görülmekte iken, frontal sinüs tutulumu literatürde ancak birkaç olguda bildirilmiştir. 58 yaşında kadın hasta 25 yıl önce alın bölgesine aldığı travma sonrası gelişen skar dokusundan başlayan akıntı nedeniyle başvurdu. Beyin MR ve Paranazal BT sonu-cunda sol frontal kemikte osteomyelite sekonder infla-masyon saptandı ve debridman uygulandı. Debridman materyali patolojik incelemesinde çok çekirdekli dev hücreler, epiteloid histiositlerden oluşan granülomlar ve kazeifikasyon nekrozu saptandı. Hastaya akciğer dışı tüberküloz tanısıyla tedavi başlandı. Sinüs tüberkülozu, nadiren primer olarak gelişebileceği gibi, komşu dokuların ya da akciğerin sekonder enfek-siyonu olarak da ortaya çıkabilir. Sıklıkla maksiller ve etmoid sinüse ait vakalar bildirilmişken, frontal sinüs tutulumuna nadiren rastlanmaktadır. Baş bölgesine ait tüberküloz enfeksiyonlarında tek başına medikal tedavi, sınırlı ve erken saptanan olgularda yeterli olmaktadır; ancak cerrahi ve medikal tedavinin birlikteliği ile tedavi başarısının yüksek olduğu bildirilmiştir.

A case of tuberculosis with frontal sinus involvement

Extrapulmonary tuberculosis (TB) is not a rare condition and can involve almost every organ. While nasal cavity and paranasal sinus involvements are quite rare, frontal sinus involvement has been reported in a few cases in literature. 58 years old female patient applied with complaints of dripping starting from the scar tissue developed after the trauma of frontal region. Inflammation secondary to osteomyelitis in left frontal bone was detected on cranial MR and paranasal CT and a debridement was performed. In the pathological evaluation of the debridement material, multi nuclear giant cells, granulomas consisted of epithelioid histiocytes and caseification necrosis were detected. A treatment was started with the diagnosis of extrapulmonary tuberculosis. Sinus tuberculosis can arise as secondary infections of adjacent tissues or lungs and rarely as a primary infection. While cases of maxillary and ethmoidal sinuses were frequently reported, frontal sinus involvement is rare. Medical treatment alone can be sufficient in limited and early diagnosed tuberculosis infections of the head, but it has been reported that more satisfactory treatment could be achieved with the combination of surgical and medical treatment.

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