Isolated Tonsillar Tuberculosis Masquerading as Malignancy: A Rare Extrapulmonary Presentation

Tuberculosis (TB) is a bacterial infection caused by the bacilli, Mycobacterium Tuberculosis (MTB). While it primarily affects the lungs, various other organs like the lymph nodes, pleura, and peritoneum can be involved in Extrapulmonary Tuberculosis (EPTB). Involvement of the tonsils, however, is extremely rare, even in a TB-endemic country like India. Tonsillar TB may occur secondary to pulmonary infection through lymphatic or haematogenous dissemination, and its presentation often mimics malignancy (fever, loss of weight). This case report contains a case of a 56-year-old male patient who presented with progressive dysphagia, significant weight loss, low-grade fever, and cervical lymphadenopathy. Clinical examination revealed a unilateral tonsillar enlargement with firm neck nodes, initially raising a strong suspicion of malignancy. Routine blood investigations were normal, and a diagnostic tonsillectomy was performed, whose histopathological examination revealed granulomatous inflammation with caseous necrosis. The diagnosis was then confirmed by microbiological evidence of MTB. The novelty of this case report lies in the isolated tonsillar involvement without active pulmonary disease, its close clinical resemblance to malignancy, and the diagnostic challenge involved. Early recognition and accurate diagnosis are crucial for initiating appropriate therapy and preventing transmission.