Unusual presentations of primary head and neck tuberculosis and review of literature

Background/purpose: The diagnosis of TB in the head & neck region is challenging due to diverse presentations and due to changing clinical pictures. The aim of this article is to report three unusual primary cases of head and neck tuberculosis in immunocompetent patients presenting to our hospital with description of their clinical presentation, appropriate diagnostic methods used and treatment response of these patients.

Methods: Three clinical cases were of primary tuberculosis of the lacrimal system, the thyroid gland and of the temporal space were clinically worked up. The aspirate from the swellings were sent for Cytology and Gene Xpert tests.

Results: The Gene Xpert tests were positive in these unusual cases and aided the Cytology in promptly confirming the diagnosis which otherwise would be missed if staining for AFB is negative. ATT was started and responded well to the treatment.

Conclusion: These cases demonstrate the importance of having a high index of suspicion for tuberculosis as a cause of head and neck swellings, especially in developing countries. It also illustrates the value of needle aspiration in such swellings and sending it for cytology and Gene Xpert for early diagnosis of tuberculosis.