Tonsillar Tuberculosis Mimicking Cancer: A Forgotten Disease

An 83-year-old immunocompetent man with no systemic disease presented to the emergency department of our hospital with severe progressive odynophagia over the last 5 months, which prevented him from eating and led to weight loss.He did not report fever, cough, or dyspnea.A year and a half earlier, after total knee replacement surgery, he developed septic arthritis with a torpid course, ultimately resulting in a supracondylar amputation of the lower limb.The patient was not diabetic and was not on any chronic treatment.He had quit smoking more than 40 years ago.The initial suspected diagnosis was tonsillar carcinoma, so a tonsillar biopsy was performed, and an unremarkable cervicothoracic CT was ordered.The tonsillar biopsy ruled out malignancy and identified ulcerated necrotizing granulomas.Acid-fast bacilli were identified, with 2-28 bacilli per 50 fields.Finally, the patient was diagnosed with disseminated tuberculosis with an active tuberculous focus in the tonsil.The aim of this paper is to update our knowledge on frequently neglected aspects of extrapulmonary tuberculosis in the head and neck, based on the case of tonsillar tuberculosis presented.