Primary tonsillar tuberculosis in a pediatric patient

Abstract

Rationale:Tuberculosis is an entity that usually affects the lungs, although extrapulmonary sites can also be involved. Tonsils are rarely affected, especially in the absence of pulmonary disease, primary tonsillar tuberculosis being a diagnostic challenge for the clinician.Patient concerns:We present the case of a 14-year-old female teenager, presented to our Pediatric Service with a 14-day history of dysphagia, odynophagia and left reflex otalgia associated with a 5 kg weight loss. Clinical examination revealed mild pharyngeal erythema, marked enlargement of the left tonsil infiltrating the lateral pharyngeal wall and the uvula and painful, mobile, nonadherent to deep bilateral latero-cervical adenopathy.Diagnosis:Positive interferon-gamma release assay (QuantiFERON-TB gold). Mantoux test reading was 16 mm.Interventions:During hospitalization, the patient received Clindamycin and Gentamicin for 3 days i.v., with discrete relief of symptoms and inflammatory markers. On the 4th day of hospitalization, treatment with Imipenem/Cilastin is started for 7 days in micro-perfusion, with tonsil hypertrophy decrease in size and favorable clinical evolution.Outcome:Tonsil hypertrophy decreased in size and patient had a favorable clinical evolution. At discharge, the patient was given a 6-month course of anti-tuberculous drug.Lessons:The particularity of this case is represented by the rarity of primary tuberculosis of tonsils in children, with unilateral involvement, displaying at the same time a common issue encountered in the current practice: the limitations and the difficult course of setting the diagnosis due to the involvement of relatives in the medical act.

Tonsillar tuberculosis mimicking tonsillar carcinoma: A case report

“…In cases of oropharyngeal tuberculosis, the tonsils are the primary site of involvement, accounting for 45 % of occurrences [ 2 ]. In the absence of lung disease, the tonsils are rarely involved [ 5 ]. Around 50 % of patients with oral tuberculosis also present with pulmonary tuberculosis.…”

“…However, the occurrence of oropharyngeal tuberculosis in a patient already being treated for pulmonary tuberculosis is rare. In fact, the upper respiratory tract including the tonsils are generally resistant to tuberculosis; due to the antiseptic and cleansing effect of saliva and the presence of saprophytes in the oral cavity, which makes colonization difficult, as well as the thickness of the epithelium, which prevents bacterial invasion [ 5 ].…”

“…Rarely does tuberculosis recur in the tonsils once the initial treatment is completely successful and the emergence of resistant strains causing relapse is rare, estimated at 1 % [ 1 , 5 , 14 ]. Nevertheless, monthly regular follow up is necessary to battle the indefatigable response to treatment and to manage any potential drug's side effects.…”

Primary Tuberculosis of Tonsils: Interesting Case Detected During the Histopathological Examination

“…A patient’s medical history and a physical examination may raise a clinician’s suspicion of tuberculosis. Laboratory testing, Ziehl-Neelsen staining, and mycobacterial culture are essential for diagnosis and must be performed in addition to histological examination for the excised lesions [ 4 ].…”

“…A review conducted by Moisa et al shows that all patients who previously reported tonsillar tuberculosis were diagnosed based on histopathological examination (54.5% tonsillectomy, 45.5% by fine needle aspiration cytology) with 95.58% positive results [ 4 ].…”