Primary Tuberculosis of Tonsils: A Case Report

Abstract

Tuberculosis is one of the major causes of ill health and death worldwide. Isolated tuberculosis of tonsil in the absence of active pulmonary tuberculosis is a very rare clinical entity. A 10-year-male child presented with recurrent episodes of upper respiratory tract infections, with 2-3 occurrences per month for the past 6 years. On general physical examination, bilateral tonsils showed grade III enlargement and congestion. Posterior pharyngeal wall was clear. Examination of the chest was within normal limits. Histopathological examination of bilateral tonsils revealed caseating and noncaseating epithelioid cell granulomas with Langhans giant cells. Ziehl-Neelsen stain for acid fast bacillus was positive. Features were consistent with a diagnosis of tuberculosis of tonsils. Tuberculosis of the oral cavity is uncommon and lesions may be either primary or secondary. Early detection and intervention is essential for cure. Isolated and primary tuberculosis of the tonsils in the absence of pulmonary tuberculosis is a rare entity, which prompted us to report this case.

Incidental Diagnosis of Primary Tuberculosis of the Palatine Tonsil in a Patient With Nasal Obstruction and Snoring

“…In the upper respiratory tract, the most common site of involvement is the larynx. Although tuberculosis of the oral cavity is uncommon, the tongue and palate are more prevalent sites, whereas the tonsil is rarely involved with an incidence of less than 5% [4]. The incidence of secondary tonsillar tuberculosis in a patient with pulmonary tuberculosis ranges from 40-80%, and for those cases whose tuberculosis is not seen on chest Xray examination, it is said to be histologically proven in about 0.2-6.2% [5].…”

“…The main route of primary tonsillar tuberculosis is infection by contact with material containing tubercle bacilli. It is believed that the causative bacteria are latent in Waldeyer's ring and cause opportunistic infection [4]. It is more common in susceptible adults with chronic alcoholism and uncontrolled diabetes, and other general immune-suppressing conditions may cause tuberculosis in areas other than the lung.…”

Extrapulmonary tuberculosis: atypical presentation in otorhinolaryngology

“…Though tonsil is a lymphoid organ and situated at a site which is frequently in contact with infected sputum, the incidence of tonsillar TB is less than 5% 9. This may be due to the antiseptic and cleansing action of saliva, presence of saprophytes preventing the colonisation and thick stratified epithelium lining the tonsil 10.…”

Tuberculosis of Waldeyer’s Ring with an Atypical Presentation as Chronic Adeno-Tonsilitis

“…But it is rare to find tuberculosis manifesting in the tonsils without any primary pulmonary focus [1]. Tuberculosis of the oral cavity is rare and the tonsillar forms are extremely uncommon [2].…”