Purpose: To present an unusual case of nasolacrimal tuberculosis that was d
iagnosed with polymerase chain reaction (PCR) and to discuss the role of PC
R as a diagnostic aid.
Methods: Case presentation with diagnostic modalities including PCR, cytopa
thologic, and histopathologic examinations with special stains.
Results: A 40-year-old woman with bilateral lacrimal drainage system obstru
ction underwent a right dacryocystorhinostomy with stents and left conjunct
ivodacryocystorhinostomy with Jones bypass tube. Although the findings of d
irect and endoscopic examinations of the nasal cavity were within normal li
mits, the tissue removed during surgery from the middle turbinate revealed
caseating granulomatous lesions on histopathologic examination. Acid-fast o
rganisms were demonstrated in postoperative nasal washings, and Mycobacteri
um tuberculosis infection was confirmed with PCR.
Conclusion: Primary tuberculosis of the nasolacrimal mucosa is rare, and it
s occurrence without any symptoms, as in this patient, is even less frequen
t. The most interesting aspect of this case was the identification of the M
, tuberculosis DNA in the mucosa of anterior turbinate and fibrous tissue w
ithin the previous surgical site. Histopathologically, the presence of case
atin,o granulomas was seen only in the nasal mucosa, indicating that PCR ma
y be of use in identifying the causative organism even in the absence of ty
pical histopathologic features.