Introduction: Tonsillar tuberculosis is an uncommon form of extrapulmonary tuberculosis, especially in children. Clinical manifestations are nonspecific and usually mimic chronic atypical tonsillitis, sometimes associated with cervical lymphadenopathy [3-7]. Diagnosis mainly relies on histopathological examination demonstrating necrotizing granulomatous inflammation.

Case presentation: We report the case of a 9-year-old child with no significant medical history who presented with a two month history of odynophagia and a mildly painful left submandibular swelling. Previous empirical antibiotic treatments failed to improve symptoms. otorhinolaryngology examination revealed bilateral tonsillar hypertrophy without exudate and a mobile, non-inflammatory left submandibular lymph node. Tonsillectomy with lymph node biopsy was performed. Gross examination disclosed caseous areas. Histopathological analysis showed epithelioid and multinucleated giant-cell granulomas associated with caseous necrosis in both tonsillar and nodal specimens, establishing the diagnosis of tonsillar and cervical nodal tuberculosis.

Conclusion: Although rare, tonsillar tuberculosis should be considered in any chronic atypical tonsillitis unresponsive to conventional therapy, especially in endemic settings. Histopathological examination of tonsillectomy specimens, possibly complemented by special stains and molecular tests, remains essential for diagnosis.