Tuberculosis (TB) remains one of the world’s most persistent infectious diseases, with pulmonary involvement being its most frequent clinical presentation. However, extrapulmonary forms of TB, although relatively rare, continue to pose diagnostic and therapeutic challenges because of their atypical and nonspecific symptoms. This report presents the case of a 35-year-old male who was admitted with gradual, progressive facial swelling, without nasal obstruction, rhinorrhea, or respiratory complaints. Given the absence of conventional symptoms of TB, the patient underwent comprehensive diagnostic evaluations to rule out neoplastic, granulomatous, or infectious conditions. Investigations included fine needle aspiration (FNA), chest computed tomography (CT), incisional biopsy of the affected area, and Ziehl-Neelsen staining, which revealed the presence of acid-fast bacilli. Histological and microbiological examinations ultimately confirmed the diagnosis of primary sinonasal tuberculosis, an extremely rare manifestation of extrapulmonary TB. The patient was started on a standard anti-tubercular regimen and monitored closely for six months, during which substantial clinical improvement was observed. Facial swelling resolved, with no evidence of recurrence. This case illustrates the diagnostic complexity of atypical presentations of TB and emphasizes the importance of maintaining a high index of suspicion, especially in TB-endemic regions. Sinonasal tuberculosis can easily mimic neoplasms or other chronic inflammatory conditions, potentially leading to misdiagnosis. Timely recognition and proper management are crucial for improving patient outcomes. This report provides valuable insight into the limited literature on primary sinonasal TB without nasal obstruction and highlights the need for increased awareness among healthcare professionals when evaluating similar head and neck presentations.
