Cold Abscess of Bilateral Parotids: Delusion or Reality?

Area of Science:

• Infectious Diseases
• Radiology
• Pathology

Background:

• Tuberculosis (TB) is endemic in India, commonly affecting the lungs but can impact any organ.
• Extrapulmonary tuberculosis is rare, and parotid gland involvement is even rarer, typically presenting unilaterally.
• Bilateral parotid gland cold abscess caused by Mycobacterium tuberculosis is an exceptionally rare clinical presentation.

Observation:

• A young female presented with bilateral, slow-growing parotid swellings and intermittent fever.
• Clinical examination revealed no signs of inflammation.
• Ultrasonography demonstrated thick-walled hypoechoic collections with septations in both superficial and deep parotid lobes.

Findings:

• Fine-needle aspiration cytology (FNAC) revealed caseating granuloma.
• Acid-fast bacilli were detected on Ziehl-Neelsen (ZN) staining, confirming tuberculosis.
• The diagnosis was established as bilateral parotid gland cold abscess due to Mycobacterium tuberculosis.

Implications:

• This case underscores the importance of considering tuberculosis in the differential diagnosis of bilateral parotid swellings, even in the absence of typical inflammatory signs.
• Prompt diagnosis via FNAC and ZN staining, followed by antitubercular therapy, is crucial for effective management.
• This presentation expands the spectrum of extrapulmonary tuberculosis and highlights its potential for rare manifestations.