Nasolacrimal tuberculosis in a patient with conjunctivodacryocystorhinostomy

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.