Hindawi Publishing Corporation Case Reports in Medicine Volume 2012, Article ID 120382, 3 pages doi:10.1155/2012/120382 Case Report Primary Tuberculosis of Tonsils: A Case Report Pooja Prasad and Minakshi Bhardwaj Department of Pathology, PGIMER and Dr. Ram Manohar Lohia Hospital, 110001 New Delhi, India Correspondence should be addressed to Pooja Prasad, poojaprasad1 02@rediﬀmail.com Received 19 October 2011; Revised 24 December 2011; Accepted 29 December 2011 Academic Editor: Peter S. Roland Copyright © 2012 P. Prasad and M. Bhardwaj. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Tuberculosis is one of the major causes of ill health and death worldwide. Isolated tuberculosis of tonsil in the absence of active pulmonary tuberculosis is a very rare clinical entity. A 10-year-male child presented with recurrent episodes of upper respiratory tract infections, with 2-3 occurrences per month for the past 6 years. On general physical examination, bilateral tonsils showed grade III enlargement and congestion. Posterior pharyngeal wall was clear. Examination of the chest was within normal limits. Histopathological examination of bilateral tonsils revealed caseating and noncaseating epithelioid cell granulomas with Langhans giant cells. Ziehl-Neelsen stain for acid fast bacillus was positive. Features were consistent with a diagnosis of tuberculosis of tonsils. Tuberculosis of the oral cavity is uncommon and lesions may be either primary or secondary. Early detection and intervention is essential for cure. Isolated and primary tuberculosis of the tonsils in the absence of pulmonary tuberculosis is a rare entity, which prompted us to report this case. 1. Introduction Tuberculosis is one of the major causes of ill health and death worldwide. Primary tuberculosis of the oral cavity and oropharynx is quite uncommon. Isolated tuberculosis of tonsil in the absence of active pulmonary tuberculosis is a very rare clinical entity [1, 2]. We report a case of primary tonsillar tuberculosis, in an otherwise healthy child, mimick- ing chronic nonspeciﬁc tonsillitis. 2. Case Report A 10-year-male child presented with recurrent episodes of upper respiratory tract infections, with 2-3 occurrences per month for the past 6 years. The patient had cough and cold associated with fever and diﬃculty in swallowing. There was a history of snoring, mouth breathing, and sleeping in the prone position. Past and family history was not signiﬁcant. The child had been on antibiotic treatment for the previous episodes, but did not respond to them. Family history was not signiﬁcant. On general physical examination, the child was of healthy build with bilateral level IIIb cervical lymphadenopathy. On oral examination, bilateral tonsils showed grade III enlarge- ment and congestion. Posterior pharyngeal wall was clear. Examination of the chest was within normal limits. Routine investigations revealed Hb-13 g%, TLC-5800/ mm3, and ESR-6 mm. Liver and renal function tests were normal. Mantoux test was positive with 18 × 20 mm indura- tion. X-ray of the chest was within normal limits. The patient was HIV seronegative. Fine-needle aspiration of the lymph nodes revealed features of reactive hyperplasia, with stain for acid fast bacillus being negative. The child underwent tonsillectomy, for a clinical diag- nosis of chronic tonsillitis. Histopathological examination of bilateral tonsils revealed caseating and noncaseating epithe- lioid cell granulomas with Langhans giant cells (Figures 1, 2, and 3). Ziehl-Neelsen stain for acid fast bacillus was posi- tive (Figure 4). Features were consistent with a diagnosis of tuberculosis of tonsils. The patient was treated with 2HRZE/4HR regimen of Isoniazid (300 mg), Rifampicin (450 mg), Ethambutol (800 mg), and Pyrazinamide (1500 mg) on alternate days thrice a week for two months, followed by Rifampicin (450 mg) and Isoniazid (300 mg) on alternate days, thrice a week for the next four months. The patient showed marked