Head and Neck Tuberculosis: Addressing Diagnostic Challenges in Clinical Practice

Objective: To enhance the awareness of the diverse manifestations of head and neck tuberculosis (HNTB) and the diagnostic hurdles it poses. Study Design: To analyze the presentation and clinical characteristics of HNTB cases. The diagnosis in all cases was established through histopathological examination of infected tissue in conjunction with medical history, TB-SPOT and other complementary TB investigations. Follow-up time 1 to 10 years. Setting: Peking Union Medical College Hospital. Methods: This retrospective study examined the clinical profiles of 60 patients diagnosed with HNTB at a tertiary university institution between 2013 and 2023.The cohort consisted of 29 men and 31 women aged 12 to 80 years (mean 43.95±16.98 years). Results: HNTB predominantly manifested in the larynx (27 cases, 45.0%), with most cases presenting with diffuse ulcerated or proliferative lesions. Notably, six patients exhibited irregular lesions on the unilateral vocal cords, mimicking early stage glottic carcinoma. The second most common localisation was in the cervical lymph nodes (20 cases, 33.33%), including cases such as retropharyngeal lymph node tuberculosis and tracheoesophageal groove lymph node tuberculosis. Conclusion: Clinicians should always consider HNTB in the differential diagnosis of lesions in this region. Given the oligobacterial nature of this disease and the absence of pulmonary involvement in the majority of cases, histopathological biopsy should be performed in cases of high suspicion. Early detection and treatment are of paramount importance to optimise therapeutic outcomes and improve the quality of life of patients.