Parotid gland tuberculosis: a case report

Pediatric Salivary Gland Pathology

Benign and malignant salivary gland disorders are uncommon in the pediatric population; however, these can be frequently seen in pediatric otolaryngology or oral and maxillofacial surgery practices. The astute clinician should be aware of the clinical presentation, diagnosis, and management options for common inflammatory, infectious, benign, and malignant disorders of salivary glands.

A Case of Primary Tuberculous Parotitis Mimicking Parotid Neoplasm: A Rare Clinical Entity

Primary tuberculous parotitis is an extremely rare entity presenting with nonspecific symptoms, variable clinical signs, and imaging features mimicking parotid neoplasm. It is a clinical and diagnostic challenge, and a confirmed histological diagnosis would indicate nonoperative management, thus avoiding unwarranted surgery and associated morbidity. Tuberculosis of the salivary gland is a relatively rare extrapulmonary manifestation of tuberculosis, with the incidence of tuberculous parotitis being 2%-9%. The prevalence of disseminated tuberculosis has increased in recent times because of the use of immunosuppressive therapy for organ transplantation and chemotherapy. However, the incidence of concurrent pulmonary tuberculosis in patients with tuberculous parotitis is a rarer scenario. Fine-needle aspiration cytology (FNAC) can confirm the diagnosis of tuberculous parotitis with a high sensitivity (84%-100%) and specificity (94%-100%). The utility of FNAC is also enhanced as the aspirate can be utilized for cartridge-based nucleic acid amplification test (CBNAAT) testing for mycobacterium and drug sensitivity testing, thereby further increasing its sensitivity and specificity. This translates to a lesser chance of unnecessary surgical intervention and the potential surgical morbidity. Here, we report a case of parotid swelling in a 72-year-old male, with no evidence of any pulmonary or systemic tuberculosis, with clinical and imaging features suggestive of parotid neoplasm but diagnosed as tubercular parotitis on FNAC. He was started on antitubercular therapy, which resulted in the progressive diminution of the size of the lesion. Primary tuberculous parotitis should be considered a possibility while managing the parotid neoplasm.

Parotid Tuberculosis as the Presenting Manifestation of Disseminated Disease in an Otherwise Asymptomatic HIV Patient

Parotid tuberculosis is not widely described in the literature. Even though a rare presentation of a commonly occurring disease, it is still missed as a differential diagnosis and often mistaken for neoplasms, eventually leading to unnecessary surgical resections. Here, we present a case of a young lady with a slowly growing unilateral parotid mass along with matted, non-tender cervical, axillary, and inguinal lymphadenopathy, who was incidentally found to have HIV with a cluster of differentiation 4 (CD4) lymphocyte count of 38 per microliter. Fine needle aspiration revealed acid-fast bacilli and CT thorax showed features of pulmonary tuberculosis, thus suggesting a disseminated tuberculosis infection. She was started on anti-tubercular and anti-retroviral therapy, after which there was a symptomatic improvement.

Tuberculous parotitis: A series of eight cases and review of literature

Although tuberculosis is a common health problem in developing countries such as India, tuberculous parotitis (tubercular involvement of parotid gland) is rarely encountered. Because of very low incidence and nonspecific symptoms, it is often misdiagnosed as parotid neoplasm. Ultrasonographic and computed tomographic findings are also noncontributory for this entity. Hence, to increase awareness about this rare entity, here, we report a series of eight cases of tuberculous parotitis which were diagnosed on fine-needle aspiration cytology (FNAC) and successfully treated with antitubercular drugs. Majority of our cases (five cases) presented as asymptomatic unilateral swelling or acute tender painful swelling (two cases) in the parotid region. FNAC smears showed caseous necrosis, epithelioid granulomas along with variable amount of mixed inflammatory exudates, and few benign ductal or acinar cell clusters. One case had unilateral recurrent swelling in the preauricular region with fistula. Superficial parotidectomy was done and histological examination revealed the diagnosis of tubercular parotitis. Following diagnosis, all patients were kept on antitubercular treatment and responded well to treatment with no evidence of recurrence on 9-month regular follow-up.

Parotid tuberculosis

Parotid gland tuberculosis is an uncommon manifestation of one of the most common infections even in the developing countries, caused by Mycobacterium tuberculosis. There are no specific symptoms or clinical signs of parotid tuberculosis, and such an infection most commonly presents as a slow growing painless parotid mass. Because of its rarity, tuberculosis of parotid gland is often mistaken for a malignant growth, and it most commonly gets diagnosed after superficial protidectomy. Complete cure is possible with standard antituberculous therapy. Most of our knowledge about this rare entity comes from case reports and short case series. The authors encountered three cases of parotid tuberculosis in the last 10 years. This article aims at presenting a comprehensive review of all the available literature and thus providing detailed information and an update on parotid tuberculosis and our experience of three cases.

Tubercular sialadenitis of parotid gland - An extremely rare case series

Tuberculosis is a potentially fatal infectious disease caused by Mycobacterium Tuberculosis. It most commonly involves the lungs (Pulmonary Tuberculosis), although it can involve any organ system in the body. However even in a country like India which has high burden of this disease, the tubercular invasion of parotid gland is extremely rare. Here we describe two such cases. Both patients were immune competent and presented with fever and swelling in the parotid region. They were diagnosed as tuberculosis of parotid gland by ultrasound guided fine needle aspiration and confirmed bacteriologically.

Tuberculosis of the parotid gland: histology surprise

The Parotid gland is rarely involved in tuberculosis, even in endemic countries. We report a case of a 26 year-old woman with no medical history, who presented with a swelling of the parotid lodge. Pathology performed after surgery found a tuberculous parotitis, and the patient received anti-tuberculous regimen with a satisfactory evolution. We discuss both diagnostic and therapeutic modalities for this infection.