Pediatric submandibular gland tuberculosis: a case report

Tuberculosis is a common systemic bacterial infectious disease usually caused by Mycobacterium tuberculosis. In India, there are an estimated 2.1 million cases of tuberculosis, with 16% of them being new extrapulmonary tuberculosis cases. Extrapulmonary tuberculosis may present in concurrence with a focus in the lungs or may be present primarily without pulmonary involvement. While primary submandibular tuberculosis is rare, it is even rarer in the pediatric age group. Diagnosis of this disease can be challenging due to nonspecific symptoms. Fine-needle aspiration cytology is helpful in diagnosis, but often an excisional biopsy is required.

We present a case of a 9-year-old female patient from Aligarh, Uttar Pradesh (India) who presented with swelling in the left submandibular region without pain for the last 25 days. After diagnosis, it was found to be primary tuberculosis of the submandibular gland. The patient did not have any history of fever, cough, weight loss, loss of appetite, or other systemic symptoms but she had a family history of tuberculosis 4 years ago. On local examination, a nontender, soft-to-firm swelling of approximately 2.5 cm × 2.0 cm was detected in the submandibular region. The diagnosis was confirmed by fine-needle aspiration cytology, which revealed granulomas most likely of tubercular etiology.

Tubercular involvement of salivary glands is uncommon, and primary involvement of the submandibular gland in the pediatric age group is extremely very rare. The disease typically manifests as a diffuse swelling in the submandibular region with or without systemic manifestations. Diagnosis is based on fine-needle aspiration cytology, polymerase chain reaction, or histopathological examination of the biopsied material, which reveals the presence of granulomas with or without caseous necrosis. Antituberculous treatment remains the mainstay of treatment.

This study unveils the rare instances of tuberculosis impacting the submandibular gland among children, underscoring the importance of increased clinical vigilance. By thorough examination of clinical cases, diagnostic approaches, and treatment strategies, this study provides a valuable perspective on the unique presentation of submandibular gland tuberculosis, ultimately enhancing diagnostic accuracy and patient care.