Tuberculous lymphadenitis is the most common manifestation of extrathoracic disease, and the most frequently nodes are cervical and caused by Mycobacterium tuberculosis. The disease in this location was known as scrofular or the King's Evil.
Tuberculous
lymphadenitis is presumed to be a rare entity and, for that reason, might be overlooked in the differential diagnosis whenever dealing with a submandibular swelling, Parotid gland involvement is very rare phenomena that require a precise
diagnosis.
Differential diagnosis involves mainely the pathologic conditions involving the regional lymph nodes and salivary glands (inflammatory, neoplastic, developmental and granulomatous disease etc). The systematic workup for ruling out tuberculosis
should
include a chest radiograh, sputum smear, curture of acid-fast bacilli, tuberculin skin test, scintigraphy and bacteria culture from the pus. Excision of the enlarged mass for confirmation of the diagnosis is recommened. Microscopic examination
show
a
granulomatous lesion with casesous necrosis surrounded by lymphocytes, epitheloid cells, and multinucleated giant cells. Long-term antitubercular chemotheraphy is sufficient to cause regression fo the affected nodes. But recently, A combined
approach of
chemotheraphy and surgical excision is recommended because of it's diagnosis and treatment.
This is a case of tuberculous lymphadenitis with submandibular swelling and parotid gland involvement and we presented the case with literature reviews, for obtaining good result by surgical excision and antituberculous medications.
|