Primary Adenotonsillar Tuberculosis in an Immunocompetent Child -A Case Report

Abstract

Introduction: Primary tuberculosis (TB) of the oropharynx and nasopharynx is an extremely rare form of extra-pulmonary TB in children. Primary tuberculosis occurs more likely secondary to pulmonary TB and is more common in immunocompromised patients.

Case report: We reported the case of a young male presented with the symptoms of non-specific chronic adenotonsillitis, mild obstructive sleep apnoea, and cervical lymphadenopathy. Subsequently, he underwent adenotonsillectomy and excision of the cervical lymph node with the tissue specimens came back strongly positive for TB. Then, he started using antituberculous medication and recovered well.

Conclusion: The authors would like to highlight this rare clinical entity in which accurate diagnosis is essential for complete treatment.

Keywords: Adenoid; Child; Tonsil; Tuberculosis.

Fig 1

Granulomas are seen here in the tonsil (left upper) with presence of a few multinucleated giant cells, which is seen lined by squamous epithelium in the right lower corner (hematoxylin-eosin; x100)

Fig 2

Granulomas also seen in the lymph node (on the right), with a reactive lymphoid follicles seen on the lower left just underneath the capsule (hematoxylin-eosin; x100)

Fig 3

The granulomas consist of central necrosis surrounded by epithelioid histiocytes. Three multinucleated giant cells are seen here (x200).

Fig 4

Ziehl-Neelsen stain show presence of an acid-fast bacilli within the multinucleated giant cell (in red) (x400).