A case report on caseating tuberculous lymphadenitis and anti-tuberculosis treatment induced hepatitis in the backdrop of undifferentiated connective tissue disorder

Abstract

Extra pulmonary tuberculosis (TB) is rare occurring in 0.05-5% of patients with tuberculosis. In this way, this disease rarely features in the differential diagnosis of head and neck lesions. We present a case of a 22-year-old female patient with a painless swelling in her left submandibular region. Her histopathology report revealed caseating granuloma – suggestive of Tuberculosis. In the backdrop of this scenario, she was also diagnosed with undifferentiated connective tissue disease. This case report presents a complication in continuing with the usual basic Anti-tuberculosis treatment regimen as our patient developed ATT induced hepatitis two months from commencing the treatment. Hence, this case scenario sheds light upon yet another challenge in actively managing extrapulmonary tuberculosis. Although manifestations of TB are atypical in head and neck area, clinicians should integrate them in the differential diagnosis.