DOI: 10.14260/jemds/2014/2599 CASE REPORT J of Evolution of Med and Dent Sci/ eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 3/ Issue 20/May 19, 2014 Page 5371 PERIPHERAL TUBERCULAR NEURITIS: AN UNUSUAL PRESENTATION OF CERVICAL NERVE Vipin R. Ekhar 1 , Sachin V. Rane 2 , Ritesh N. Shelkar 3 , S. K. T. Jain 4 , Ashok Garje 5 HOW TO CITE THIS ARTICLE: Vipin R. Ekhar, Sachin V. Rane, Ritesh N. Shelkar, S. K. T. Jain, Ashok Garje. “Peripheral Tubercular Neuritis: An Unusual Presentation of Cervical Nerve”. Journal of Evolution of Medical and Dental Sciences 2014; Vol. 3, Issue 20, May 19; Page: 5371-5374, DOI: 10.14260/jemds/2014/2599 ABSTRACT: Tuberculosis, one of the major infectious diseases in India. It can involve many organs of human body but the primary involvement of nerve tissue is very unusual & uncommon. Present study reports 69 yrs. old lady with left sided neck swelling which was first diagnosed as External jugular vein thrombosis. But histopathological features of excised specimen showed tubercular neuritis. KEYWORDS: Tuberculosis, neuritis, anti-tubercular drugs. INTRODUCTION: The number of true infectious diseases of peripheral nerves is small. Peripheral polyneuropathy commonly occurs following exanthematous fevers and as a complication of various acute bacterial infections, but it is highly doubtful whether there is direct invasion of the nerves by micro-organisms.The causative association of peripheral neuropathy with tuberculous infection is controversial. Many possibilities have been suggested; with no definite single cause. The tubercular nerve involvement is very rare. Few cases of cranial nerve involvement have been reported, however peripheral nerve involvement by tubercular granulomas is not reported in available literature. This report describes rare finding of tuberculous granulomas in cervical region with tuberculous involvement of a peripheral nerve-Greater auricular nerve (C2, C3) in a patient, who clinically presented with painful neck swelling. The granulomas may have disrupted the endoneurial blood supply, producing the acute Wallerian-type degeneration of the nerve which was perceived by the patient as pain in the neck swelling. We want to stress the fact that, it should never be assumed that neuropathy in patients with tuberculosis is iatrogenic, and the possibility of a primary affection of the nerves should be considered. CASE REPORT: 69 yrs. old female patient presented to ENT OPD with complaints of swelling over left side of neck since 3 months & pain over the swelling since 2 weeks. The patient noticed the swelling 3 months back about 3cms from the angle of mandible and had the history that the swelling slowly elongated in the downward direction so that by the time she presented to us it was about 5cm in length and 1 cm in width (Fig. I). She was also having severe pain in the region and the swelling was gradually increasing in length. No history of similar complaints in past or Koch’s or Koch’s contact. There was no history of similar swelling in any other part of the body. There was no history of trauma to that area, no history of bleeding disorder, diabetes mellitus or hypertension. On examination there was a cord-like linear swelling about 5 cm in length on the antero-lateral part of neck overlying the sternocleidomastoid muscle. The swelling was extremely tender on palpation. The skin over the area was inflamed especially towards the lower end of the swelling. There was no other significant cervical lymphadenopathy. We kept the diagnosis of acute cervical lymphadenopathy and started her on antibiotics and anti-inflammatory drugs. In spite of treatment, the lesion gradually increased in size and continued to be tender.