Primary tonsillar tuberculosis: A challenging clinical diagnosis a cases series

Tonsillar tuberculosis, a rare observed presentation of Mycobacterium tuberculosis affecting the palatine tonsils. Often secondary and associated with concurrent pulmonary tuberculosis, it may clinically manifest as chronic or recurrent tonsillitis, occasionally mimicking malignant conditions. Diagnosis of this condition is often delayed and complex, frequently necessitating histopathological examination for confirmation. Its management predominantly hinges on antitubercular medications.We present two distinct cases of tonsillar tuberculosis. The first case involves a 64-year-old male receiving anti-TNF therapy for ulcerative colitis. He was hospitalized for lateral neck swelling and persistent ulceronecrotic angina despite initial antibiotic treatments. Tonsillar tuberculosis was suspected and confirmed by histopathological analysis. The second case involves a 46-year-old female presenting with right ulceronecrotic angina associated with ipsilateral jugulo-carotid adenopathy. The diagnosis of caseous-follicular tonsillar tuberculosis was confirmed by biopsy. The patient was initiated on antitubercular treatment for a period of 6 months, resulting in a significant improvement in symptoms. Neither patient had pulmonary tuberculosis.