Tuberculosis diagnosis

Sir, a 37-year-old woman was referred by her general medical practitioner with a two-month history of an increasing right-sided facial swelling. She has been resident in the UK for ten years with no history of cough, weight loss or recent travel. On examination, there was a 3 cm raised, fluctuant lesion on the lower border of the mandible (Fig. 1). The orthopantogram and chest X-ray were unremarkable. Computed tomography showed a cystic collection at level 1b. Fine needle aspiration proved inconclusive. An excisional biopsy showed tuberculous lymphadenitis.¹ Persistent lymphadenopathy of over four weeks' duration in people other than white UK-born should be regarded as tuberculosis until proven otherwise.²

Figure 1

Non-erythematous, non-tender lesion on right lower border of mandible