A 25-year-old male patient presented with a swelling in the left submandibular region (just inferior to the angle and body of the mandible) associated with pain for two months. There were no "B symptoms" (constitutional symptoms) and symptoms suggestive of pulmonary tuberculosis. The patient was immunocompetent and there was no family history of tuberculosis. The patient consulted a dentist and he was treated with antibiotics. Due to continuing pain and increase in size of the swelling, the patient was referred to surgical outpatient department. His general physical examination was unremarkable. Local examination detected a diffuse, non-tender, firm, bi-digitally palpable swelling of 8 cm x 5cm in the left submandibular region. The skin overlying the swelling was normal. The swelling was not fluctuant. There was no purulent discharge from the Wharton's duct. The rest of the oral cavity and oropharyngeal examination was unremarkable. The cervical lymph nodes were not palpable. The rest of the systemic examination revealed no abnormality.
The complete blood count was normal except for a raised ESR of 68 mm. LFT including the liver enzymes and serum proteins were within normal limits. ELISA for HIV and HBs Ag were non-reactive. The FNAC from the swelling showed a few granulomas comprising epithelioid cells, Langhan's giant cells, and lymphocytes with central caseation necrosis. Special stains for AFB were negative. These features were suggestive of tuberculous sialadinitis. Chest X-ray did not reveal any pulmonary lesion. The radiograph did not show any abnormality in the mandible. PCR for mycobacterium tuberculosis was positive. Patient was started on ATT, i.e., INH 300 mg, Rifampicin 450 mg, Pyrazinamide 1500 mg, and Ethambutol 800 mg for 2 months; INH 300 mg and Rifampicin 450 mg for 7months. The swelling had completely disappeared at the end of the treatment period. At 8 months post-ATT follow-up, the patient was asymptomatic without any swelling.