Tuberculosis of the Submandibular Gland: A Diagnostic Pitfall

Background: Tuberculosis remains a major public health problem worldwide, with persistent endemicity in Morocco. While cervical lymph node involvement is the most frequent ENT localization, extranodalpresentations such as salivary gland tuberculosis are rare and often misleading, raising diagnostic challenges with neoplastic pathologies. Case Presentation: We report the case of an 11-year-old girl presenting with a painless, firm left submandibular swelling evolving over 21 days, unresponsive to antibiotic therapy. Initial laboratory tests revealed an elevated erythrocyte sedimentation rate, with no other abnormalities. Ultrasound suggested a suppurativesubmandibulitis of bacterial origin, while cervical CT scan showed heterogeneous submandibular involvement with necrotic lymph nodes, suggestive of tuberculosis. Diagnosis was confirmed by GeneXpert detection of Mycobacterium tuberculosis from pus, and histopathological findings of epithelioid giant-cell granulomas with caseous necrosis. The patient tested HIV-negative and had no other tuberculous localizations. She received a six-month anti-tuberculous treatment with favorable clinical outcome. Discussion: Submandibular gland tuberculosis is exceptionally rare, with fewer than 40 cases reported in the literature. Its clinical presentation mimics benign or malignant tumors, often leading to misdiagnosis. Imaging can provide suggestive features, but histopathology and microbiological confirmation remain the diagnostic gold standards. Conclusion: Extra-ganglionic tuberculosis of the submandibular gland is a diagnostic pitfall due to its rarity and misleading clinical presentation. Histopathological confirmation is essential, and medical management with anti-tuberculous therapy ensures favorable prognosis.