Unusual presentations of tuberculosis in East London

Introduction: Ear, nose and throat (ENT) manifestations of tuberculosis (TB) are rare. Few case series detailing these presentations in a high-income, low TB-incidence country are available. Methods: We conducted a retrospective analysis of all TB cases at a large centre in East London between 2005 and 2015 to identify cases of ear, parotid gland, tonsil and nostril TB. Results: From a total of 5171 cases, 9 patients presented with either ear, parotid gland, tonsil or nostril TB (0.17%). There were 6 males and 3 females with a mean age of 37.5 years. Patients’ ethnic origins were Asian (6), Caucasian (1) and African (2). 4 patients presented with ear abscesses, 2 presented with parotid abscesses, 1 with tonsillar abscesses and 1 patient presented with TB of the nostrils. ENT TB was the primary presentation in 6 patients. 1 patient had co-existent pulmonary TB. Axillary lymphadenopathy was found in 1 patient. 6 patients were culture positive for M. tuberculosis; 5 patients had fully sensitive disease, one was isoniazid resistant. Ultrasound was performed in 4 patients; fluid collections were observed in 1 and solid lesions in 3 patients. Histology was examined in 8 patients; 1 showed necrotising granulomata, of which 1 was positive on Ziehl-Neelsen (ZN) stain; 5 showed non-necrotising granulomata, 4 were ZN positive, and 2 showed inflammatory change only. All patients received anti-TB treatment. 7 received treatment for 6 months, 2 for 12 months, leading to resolution in all cases. None of the patients experienced recurrence. Conclusion: Isolated ENT lesions (not-including lymph node TB) remain a rare but important cause of TB and atypical presentations render diagnosis challenging.