Parotid tuberculosis: A diagnostic dilemma

Abstract

Tuberculosis of the parotid gland is a rare condition, even in endemic countries. It usually presents as a slow growing swelling, which can be mistaken for a neoplasm of the parotid gland. Diagnosis is by high suspicion and demonstration of epithelioid granulomas on fine needle aspiration cytology (FNAC). Herein, we report a case of parotid tuberculosis, secondary to pulmonary tuberculosis, in a 50-year-old female patient diagnosed by FNAC and treated successfully with anti-tuberculosis regimen. ARTICLE HISTORY

Cold Abscess of Bilateral Parotids: Delusion or Reality?

“…Its incidence is high in developing countries, like India. [ 8 ] However, nowadays, it is increasing in developed countries too due to the emergence of resistance strains and coinfection with HIV. [ 3 8 9 ]…”

“…In addition, the continuous flow of saliva prevents the inoculation of mycobacteria within the gland parenchyma. [ 5 8 ] Bilateral involvement of the parotid gland is even more uncommon. [ 6 ] The first case of tubercular parotitis was diagnosed in 1893 by C De Poali.…”

Tuberculous parotitis in an immuno-competent adult: A rare clinical entity

“…It commonly present as a painless mass which results from infection of intracapsular or pericapsular lymph nodes, parotid abscess, sialadenitis or as pre-auricular fistula. 7 Parotid tuberculosis becomes a real diagnostic problem in the absence of clinical disease in the lung and without any systemic signs and symptoms. 15 Our case presented with a primary parotid abscess with no involvement of the lung or any other extrapulmonary sites.…”

“…16 FNAC is advocated as a useful and reliable technique for the diagnosis of tuberculosis in the parotid gland, 14,17,18 due to its high sensitivity of 81-100% and specificity of 94-100%. 7 However, FNAC is not always contributory to a diagnosis in large parotid mass as these are often necrotic. 19 AFB staining requires the presence of many bacteria to be detected histopathologically, and culture can take up to 6 weeks to return a result.…”

“…The diagnosis of parotid tuberculosis needs a high degree of clinical suspicion but this is commonly overlooked by the treating physician. 7 The rarity of this condition has been the main drawback to diagnose the entity by conventional means of identifying Mycobacterium tuberculosis, the organism responsible for the disease. As a result, histology of a surgical specimen has been commonly used to diagnose TB parotitis.…”