Pediatric Primary Parotid Tuberculosis: Case Report and Literature Review

Abstract

Tuberculosis (TB) is an airborne infection disease, caused by Mycobacterium tuberculosis or Mycobacterium bovis considered among the leading causes of mortality in India. The present case describes a rare case of primary parotid gland tuberculosis in a 12-year-old child, and highlights the diagnostic challenges associated with this condition. A 12-year-old child with no significant medical history presented with a progressively enlarging, painless swelling of the right parotid region. Physical examination revealed a soft, mobile mass measuring approximately 3 cm, with no facial nerve involvement or intraoral purulent discharge. MRI suggested a cystic lesion, initially favouring a pleomorphic adenoma. Laboratory investigations were normal except for a mildly elevated erythrocyte sedimentation rate. The patient underwent a conservative parotidectomy, and histopathological analysis of the specimen revealed epithelioid and giant cell granulomas with caseous necrosis, confirming tuberculosis. Antituberculous therapy was administered for 6 months. Parotid tuberculosis is extremely rare, especially in children, and may mimic benign or malignant parotid tumours. Clinical, radiological, and biological findings are often nonspecific, making the diagnosis challenging. Fine-needle aspiration cytology and PCR-based methods can aid diagnosis and reduce unnecessary surgery, but histopathology remains the gold standard. Management is primarily medical, with prolonged antituberculous therapy leading to favourable outcomes. Although exceptionally rare in children, primary parotid tuberculosis should be considered in the differential diagnosis of parotid masses, particularly in endemic regions. It is recommended that early recognition and appropriate medical management can prevent unnecessary surgery and ensure rapid recovery.