Primary Tuberculosis of Tonsil in a Diabetic Patient—A Case Report

Nagula Parusharam¹, Kamreddy Ashok Reddy¹, Lokesh Rao Magar², Jadi Lingaiah³

¹Department of E.N.T., Kakatiya Medical College, MGM Hospital, Warangal, India.
²Department of Pathology, Kakatiya Medical College, MGM Hospital, Warangal, India.
³Department of ENT & HNS, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, India.

DOI: 10.4236/ijohns.2015.43032                

Abstract

Though Tuberculosis is one of the most common causes of ill health and death worldwide, people with diabetes have 2 - 3 times higher risk of tuberculosis when compared with people without diabetes. Though tuberculosis can affect any part of the body, oral and oropharyngeal tuberculosis is rare, but reported. And it’s association with diabetes mellitus because of the decreased host mechanism, is still rare, but reported. A 50-year-old female diabetic who was on insulin therapy came to OPD of MGM hospital, Kakatiya Medical College, Warangal with complaints of severe pain in throat for the last 6 months. On examination, right tonsil was enlarged with granular surface. Left tonsil and rest of the oropharynx were normal. Examination of chest was normal and there was no evidence of pulmonary tuberculosis. Punch biopsy revealed tuberculosis of tonsil. Isolated cases of primary tuberculosis of tonsil without evidence of pulmonary tuberculosis are rare. Presence of diabetes mellitus makes patients 2 - 3 times more vulnerable for tubercular infection.

Keywords

Tonsil, Primary Tuberculosis, Diabetes Mellitus

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Kant, S., Verma, S.K. and Sanjay (2008) Isolated Tonsil Tuberculosis. Lung India, 25, 163-164. http://dx.doi.org/10.4103/0970-2113.45284
[2]	WHO (2011) www.who.int/tb/publications/2011
[3]	Skowroński, M., Zozulińska-Ziólkiewicz, D. and Barinow-Wojewódzki, A. (2014) Tuberculosis and Diabetes Mellitus—An Underappreciated Association. Archives of Medical Science, 10, 1019-1027. http://dx.doi.org/10.5114/aoms.2014.46220
[4]	Viswanathan, V., Kumpatla, S., Aravindalochanan, V., et al. (2012) Prevalence of Diabetes and Pre-Diabetes and Associated Risk Factors among Tuberculosis Patients in India. PLoS ONE, 7, e41367. http://dx.doi.org/10.1371/journal.pone.0041367
[5]	Balakrishnan, S., Vijayan, S., Nair, S., et al. (2012) High Diabetes Prevalence among Tuberculosis Cases in Kerala, India. PLoS ONE, 7, e46502. http://dx.doi.org/10.1371/journal.pone.0046502
[6]	Gupta, S., Shenoy, V., Mukhopadhyay, C., Bairy, I. and Muralidharan, S. (2011) Role of Risk Factors and Socio-Economic Status in Pulmonary Tuberculosis: A Search for the Root Cause in Patients in a Tertiary Care Hospital, South India. Tropical Medicine & International Health, 16, 74-78. http://dx.doi.org/10.1111/j.1365-3156.2010.02676.x
[7]	Pablos-Méndez, A., Blustein, J. and Knirsch, C. (1997) The Role of Diabetes Mellitus in the Higher Prevalence of Tuberculosis among Hispanics. American Journal of Public Health, 87, 574-579.
[8]	Restrepo, B., Camerlin, A., Rahbar, M., et al. (2011) Cross-Sectional Assessment Reveals High Diabetes Prevalence among Newly-Diagnosed Tuberculosis Cases. Bulletin of the World Health Organization, 89, 352-359. http://dx.doi.org/10.2471/BLT.10.085738
[9]	Corbett, E., Watt, C., Walker, N., et al. (2003) The Growing Burden of Tuberculosis: Global Trends and Interactions with the HIV Epidemic. JAMA Internal Medicine, 169, 1009-1021. http://dx.doi.org/10.1001/archinte.163.9.1009
[10]	Restrepo, B., Fisher-Hoch, S., Smith, B., Jeon, S., Rahbar, M. and McCormick, J. (2008) Short Report: Mycobacterial Clearance from Sputum Is Delayed during the First Phase of Treatment in Patients with Diabetes. The American Journal of Tropical Medicine and Hygiene, 79, 541-544.
[11]	Farer, L.S., Lowell, A.M. and Meader, M.P. (1992) Extra Pulmonary Tuberculosis in USA. American Journal of Epidemiology, 109, 205-217.
[12]	Lathan, S.R. (1971) Tuberculosis of the Palate. Journal of the American Medical Association, 216, 521. http://dx.doi.org/10.1001/jama.1971.03180290095030
[13]	Cleary, K. and Batsakis, J.G. (1955) Mycobacterial Disease of the Head and Neck: Current Perspective. Annals of Otology: Rhinology and Laryngology, 104, 830-833. http://dx.doi.org/10.1177/000348949510401015
[14]	Balasubramanian, T. (2012) Tonsillar Tuberculosis: A Literature Review. Otolaryngology Online.
[15]	Miller, F.J., Seal, W. and Taylor, M.D. (1963) Tuberculosis in Children. J & A Churchill Ltd., London.
[16]	Verma, A., Mann, S.B.S. and Randotra, B. (1989) Primary Tuberculosis of the Tongue. Ear, Nose and Throat Journal, 68, 719-720.
[17]	Rauch, D.M. and Freidman, E. (1978) Systemic Tuberculosis Initially Seen as an Oral Ulceration: Report of a Case. Journal of Oral Surgery, 36, 384-389.
[18]	Selimoglu, E., Sütbeyaz, Y., CiftCioglu, M.A., Parlak, M., Esrefoglu, M. and Oztürk, A. (1995) Primary tonsillar tuberculosis: a case report. The Journal of Laryngology & Otology, 109, 880-882. http://dx.doi.org/10.1017/S0022215100131573
[19]	Adiego, M.I., Millán, J., Royo, J., Dománguez, L., Castellote, M.A., Alfonso, J.I. and Vallés, H. (1994) Unusual Association of Secondary Tonsillar and Cerebral Tuberculosis. Journal of Laryngology and Orology, 108, 348-349. http://dx.doi.org/10.1017/S0022215100126738