Tuberculosis as a Cause of Rapid Salivary Gland Swelling in
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Despite being a common infection, tuberculosis of the major salivary glands is rarely encountered in daily clinical practice. As a result, it is often misdiagnosed as a parotid neoplasm.

A 77-year-old man was admitted to the internal medicine department for a 5-day history of progressive preauricular swelling. Two lines of antibiotic treatment failed to achieve any improvement. Fine needle aspiration cytology was conducted and smear staining with the Ziehl-Neelsen stain as well as a PCR test were positive for Mycobacterium tuberculosis. These results were confirmed with culture of the sample. A diagnosis of tuberculosis parotitis was made and anti-tuberculous drugs were initiated.

A non-contrast neck scan was performed; it showed the presence of a significant infiltration of the left parotid compartment with parotitis without any detected collection. The infiltration extended to the left latero-cervical part of the compartment up to the base of the neck with fat infiltration, thickening of the skin and thickening of the superficial cervical fascia.

Smear staining with the Ziehl-Neelsen stain as well as a PCR test were positive for Mycobacterium tuberculosis. These results were confirmed with culture of the sample. The patient was diagnosed with tuberculous parotitis and anti-tuberculous drugs were initiated. Chest radiography was normal and the Tuberculosis Skin Test (PPD) was 12 mm.

Conclusively, Tuberculous parotitis is a rare entity but it should be suspected in patients not responding to usual antibiotic treatment. Its diagnosis requires a high index of clinical suspicion.

Source: https://www.ejcrim.com/index.php/EJCRIM/article/view/1505/1964
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