Tuberculous granulomatous inflammation associated with adenoma of parathyroid gland manifesting as primary hyperparathyroidism

A 36-year-old female presented with generalized bone pain, muscular weakness, and enlarged cervical lymph nodes. The biochemical findings and skeletal survey were suggestive of primary hyperparathyroidism (PHPT). CT of neck and thorax showed enlarged multiple lymph nodes in the cervical and superior mediastinal region. With a diagnosis of PHPT, she underwent cervical exploration and excision of enlarged right inferior parathyroid gland, along with biopsy of nodes. Histopathology revealed the features of parathyroid adenoma with a few foci of epithelioid granuloma and granulomatous lymphadenitis. Smear and culture were negative for AFB. A positive PCR for Mycobacterium tuberculosis of the homogenates of parathyroid tumor confirmed tuberculous inflammation within the parathyroid adenoma. To the best of our knowledge, this is the first reported case of parathyroid adenoma associated with tuberculous pathology in a case of PHPT.