Tuberculous parotitis: a review of seven cases

Tuberculous parotitis is rare even in countries where tuberculosis is widespread. We evaluated seven patients with tuberculous parotitis together with clinical and histopathologic findings, and management.

In a period of 13 years, seven patients (5 males, 2 females; mean age 32 years; range 23 to 47 years) were diagnosed and treated for tuberculous parotitis. All the patients had a clinical suspicion of a parotid gland tumor.

The lesions were localized on the left in four patients, and on the right in three patients. The duration of disease varied from seven months to three years. The masses were localized, mobile, and measured 3 to 6 cm in diameter; one was fistulized. There was no evidence for active pulmonary tuberculosis. Chest radiograms showed old tuberculous lesions in two patients. The PPD skin test results were positive (>12 mm induration) in five patients (71%). Computed tomography or magnetic resonance imaging obtained in five patients showed mass formation suggesting a benign parotid gland tumor. Fine-needle aspiration cytology performed in three patients and cultivation performed in the fistulized case were all non-diagnostic. Superficial parotidectomy was performed in six patients and enucleation was performed in one patient. Histopathologic examination showed tubercles composed of macrophages, epithelioid cells and Langhans giant cells, and central caseous necrosis. Following diagnosis, all patients were treated with a four-drug chemotherapy regimen. There was no evidence for recurrence within a mean of 15-month follow-up.

Tuberculosis of the parotid gland should be considered in the differential diagnosis of patients presenting with a solitary tumor in the parotid gland.