Nasopharyngeal tuberculosis mimicking malignancy on MRI: A rare clinical entity in an immunocompetent adult

Abstract

Nasopharyngeal tuberculosis (NPTB) represents an uncommon manifestation of extrapulmonary tuberculosis and may closely simulate malignant disease on magnetic resonance imaging, particularly when it exhibits aggressive features. Its rarity and nonspecific clinical presentation often lead to a significant diagnostic challenge. We report the case of a 41-year-old immunocompetent woman presenting with chronic right-sided headaches and hearing loss, in whom MRI revealed a large infiltrative mass arising from the right posterolateral wall of the nasopharynx with extension to adjacent deep spaces, raising strong suspicion of malignancy. Histopathological examination of biopsy specimens demonstrated necrotizing granulomatous inflammation with central caseous necrosis, and PCR testing confirmed infection with Mycobacterium tuberculosis . The patient was treated with standard antituberculous therapy, resulting in complete clinical and radiological resolution. This case highlights that nasopharyngeal tuberculosis should be considered in the differential diagnosis of aggressive nasopharyngeal masses, even in immunocompetent patients without systemic symptoms, and underscores the essential role of histopathological confirmation.