Abstract
Abstract Tuberculosis of parotid gland is a rare entity only about a hundred cases have been reported till date. An associated tubercular otitis media is very rare. The present case was diagnosed by montoux test and treated successfully by ATT. A 26-year old lady attended our OPD with complaints of swelling over rt. parotid area and discharge from rt. ear since 5 and 3 months respectively. clinical examination, revealed a, non tender, soft, fluctuant parotid swelling of 4×2 cm, with rt. level 1b lymphadenopathy and granulations at annulus and dull, lustureless retracted TM with discharge. FNAC of parotid and granulation biopsy revealed epitheloid and giant cells with no caseation. Z-N stain for AFB, chest radiograph, serum ACE levels were unremarkable. Montoux test was positive (20FNx0120mm) and ESR was 42 mm/hr. A CT scan showed isodense mass with hypodesne centre and rim enhancement in the rt. parotid gland and MRI on T2W images had mastoiditis and middle ear mucosal disease. The patient was advised ATT and had remarkable improvement. Parotid gland and middle ear tuberculosis is rare. FNAC and Z-N staining of the aspirate, should be routinely done. Further an AFB negative presumptive diagnosis by this method may prompt a trial of ATT which can be rewarding.
Highlights
Tuberculosis in the parotid gland is an infectious disease, which manifests by an increase in the gland volume, making it lobulated and causing lymphadenitis
Few cases of tuberculosis of the parotid gland with middle ear affliction have been reported in the literature
We report a case of a young woman who had parotid swelling initially, followed by mastoiditis, which was provisionally diagnosed to be of tubercular origin [acid fast bacilli (AFB) −ve, Mantoux test +ve] without lung involvement and had excellent response to antitubercular treatment (ATT)
Summary
Tuberculosis in the parotid gland is an infectious disease, which manifests by an increase in the gland volume, making it lobulated and causing lymphadenitis. Few cases of tuberculosis of the parotid gland with middle ear affliction have been reported in the literature. It is difficult to assess its true incidence, as the large series of patients reported has been selected from hospitalized subgroups with established tuberculosis [1]. These patients usually have the initial symptom of painless otorrhoea. We report a case of a young woman who had parotid swelling initially, followed by mastoiditis, which was provisionally diagnosed to be of tubercular origin [acid fast bacilli (AFB) −ve, Mantoux test +ve] without lung involvement and had excellent response to antitubercular treatment (ATT). The patient was observed for signs of healing regularly, and upon noticing the improvement after 2 weeks, it was decided to complete the regime of 6 months (Fig. 3)
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