Tuberculous Tonsillitis in a Patient Treated with an Anti-TNF Ag

  • Sara Ferreira Centro Hospitalar de S. João, Serviço de Medicina Interna
  • Paula Vaz-Marques Centro Hospitalar S. João, Serviço de Medicina Interna


Tuberculous tonsillitis, adalimumab


Tuberculosis remains a concern in patients receiving anti-TNF therapy as these individuals have a higher incidence of extrapulmonary and disseminated tuberculosis. Tuberculous tonsillitis is an unusual presentation of extrapulmonary tuberculosis, which is diagnosed mostly in immunodeficient patients. We report the case of a 33-year-old woman, diagnosed with Behçet’s syndrome, immunosuppressed with adalimumab, cyclosporine and prednisolone. She had odynophagia for 2 weeks, fever and a hypertrophied, ulcerated left tonsil. A tonsil biopsy revealed a granulomatous inflammatory process. Ziehl-Neelsen staining was positive for acid-fast bacilli. The chest x-ray revealed a milliary pattern. Gastric juice was positive for Mycobacterium tuberculosis complex DNA. A diagnosis of tonsillar and pulmonary tuberculosis was established. This case report highlights the low threshold for a tuberculosis diagnosis in unusual locations in patients treated with anti-TNF therapy. 



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  • Published: 2017-10-30

    Issue: Vol 4 No 8 (view)

    Section: Articles

    How to cite:
    Ferreira, S., & Vaz-Marques, P. (2017). Tuberculous Tonsillitis in a Patient Treated with an Anti-TNF Ag. European Journal of Case Reports in Internal Medicine, 4(8).