Bilateral tuberculous parotitis with facial nerve palsy: The first case report

Tuberculosis of salivary glands is a rare condition, even in endemic countries like Pakistan. Tuberculosis of the parotid gland is even rarer and with cases of bilateral tuberculous parotitis being even more unique. For the first time in literature, we report a novel case of bilateral tuberculous parotitis with facial palsy in a thirty-eight-year old female with no previously known comorbidities. The female presented with bilateral painful parotid swelling and a long history of constitutional symptoms. Diagnosis of tuberculous parotitis was confirmed with ultrasound guided fine needle aspiration cytology which revealed variable sized granulomas containing epithelioid cells, macrophages and mature lymphocytes and a positive acid-fast bacilli smear. Patient was treated with anti tubercular drugs (Isoniazid, Rifampicin, Pyrazinamide, Ethambutol) to which she responded well and after three months of therapy her swelling and facial weakness improved significantly. In addition to reporting a completely new kind of presentation, this paper reviews relevant literature and stresses the need for a high degree of suspicion for tuberculous parotitis in a patient with chronic parotid swelling. Use of fine needle aspiration is important so that this curable condition can be diagnosed and medically treated. In this way, surgical intervention can be avoided and further complications can be prevented.