www.iaset.us editor@iaset.us GREAT AURICULAR NERVE TUBERCULOSIS: CASE REPORT AND REVIEW RAMESHWAR NATH CHAURASIA 1 , SHALINI JAISWAL 2 , VIJAY NATH MISHRA 3 & DEEPIKA JOSHI 4 1,3,4 Department of Neurology, Institute of Medical Sciences, Banaras Hindu University Varanasi, Uttar Pradesh, India 2 Department of Radiodiagnosis, Suvidha Diagnostic centre, Bhelupura, Varanasi, Uttar Pradesh, India ABSTRACT Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis, a quite common health problem in many developing countries including India. Peripheral neuropathy due to tuberculosis is rare and a bit controversial. Here we report a 30 years old male clinically presenting with a tubular swelling in right lateral aspect of neck for last 10 months, which later proved to be due to tuberculous neuritis of great auricular nerve (GAN), pathologically. KEYWORDS: Anti Tubercular Treatment, Great Auricular Nerve, Multi Drug Therapy, Tuberculous Neuropathy ABBREVIATIONS Tuberculosis (TB), Great Auricular Nerve (GAN), Peripheral Nervous system (PNS), Multi drug Therapy (MDT), Human Immunodeficiency Virus (HIV), Fine Needle Aspiration Cytology (FNAC) INTRODUCTION Involvement of the peripheral nervous system (PNS) by Mycobacterium tubercuosis, is controversial and rare. Many possibilities have been studied, with no definite single cause [1]. Possibilities include the toxic effects of anti tubercular drugs (especially, rifampicin, streptomycin & ethambutol), immune mediated neuropathy, leprosy, sarcoidosis, vasculitic neuropathy, compressive neuropathy, and meningitic reaction. The causative association of peripheral neuropathy with tuberculous infection is rare and till date only few cases have been reported [2, 3, 4]. We are reporting a rare case of a patient who developed tuberculosis of great auricular nerve. CASE PRESENTATION A 30 year old male presented to our neurology out-patient clinic with a cord like swelling localised to right lateral aspect of neck for last 10 months. Along with this he also noticed some discoloration over face and ear on same side. On examination there was a tubular, firm cord like, subcutaneous tender lump (of approx. 5cm×1.2cm) on right lateral aspect of neck along with reddish discoloration on ipsilateral aspect of cheek involving the skin over mandibular ramus, right parotid, lower concha and ear lobule i.e. along the typical distribution of anterior and posterior branches of Great Auricular Nerve (Figure 1). Sensory examination showed impaired pain and temperature sensation on corresponding area. Rest of nervous system examination was normal. Other systemic examination like respiratory and abdomen were normal. General examination including lymph node evaluation revealed no abnormality. Patient had initially taken six months multi drug therapy (MDT) for leprosy from elsewhere without any improvement. Initially there was no patch but after few weeks of multi drug therapy, there was appearance of pigmented patches in the skin in the above mentioned distribution. Drugs included in MDT were Rifampicin, Doxycycline and Clofazimine International Journal of General Medicine and Pharmacy (IJGMP) ISSN(P): 2319-3999; ISSN(E): 2319-4006 Vol. 4, Issue 6, Oct - Nov 2015, 9-12 © IASET