Case Report: Parotid Tuberculosis: About a Case Report Mimicking a Tumoral Origin in a Child

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It is often confused with malignant tumors because of the similarity of the clinical presentation (the presence of a progressive and abscessed parotid swelling) We present the case of a 4-year-old girl who presented with chronic indurated right parotid gland swelling evolving from one month with fever. Clinical examination objectified a painful, indurated right parotid mass measuring 7 cm with ipsilateral grade 2 right peripheral facial palsy. Imaging showed a solid-cystic parotid mass with lysis of the mandibular condyle. Malignancy was suspected. However, biopsy confirmed tuberculosis. Pulmonary tuberculosis was ruled out. The patient responded well to anti-tuberculosis therapy, showing significant improvement after six months. Parotid gland tuberculosis is very rare and can mimic malignant tumors. It is crucial to rule out this diagnosis, especially in countries where tuberculosis is common, during the diagnosis process." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/14-1047/v1", "name": "Case Report: Parotid Tuberculosis: About a Case Report Mimicking a..." } } ] } Home Browse Case Report: Parotid Tuberculosis: About a Case Report Mimicking a... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Khbou A, Meherzi S, Hammami A et al. Case Report: Parotid Tuberculosis: About a Case Report Mimicking a Tumoral Origin in a Child [version 1; peer review: 1 approved] . F1000Research 2025, 14 :1047 ( https://doi.org/10.12688/f1000research.169355.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Case Report Case Report: Parotid Tuberculosis: About a Case Report Mimicking a Tumoral Origin in a Child [version 1; peer review: 1 approved] Amin Khbou https://orcid.org/0000-0002-4360-2349 1 , Samia Meherzi https://orcid.org/0009-0001-9915-9876 1 , Amal Hammami 2 , [...] Oumaima Hamdani 1 , Marwa Telmoudi https://orcid.org/0009-0006-1284-1407 3 , Anis Kerkeni https://orcid.org/0009-0001-9915-8283 3 , Islem Dakhli 1 Amin Khbou https://orcid.org/0000-0002-4360-2349 1 , Samia Meherzi https://orcid.org/0009-0001-9915-9876 1 , [...] Amal Hammami 2 , Oumaima Hamdani 1 , Marwa Telmoudi https://orcid.org/0009-0006-1284-1407 3 , Anis Kerkeni https://orcid.org/0009-0001-9915-8283 3 , Islem Dakhli 1 PUBLISHED 06 Oct 2025 Author details Author details 1 ENT department, University of Sousse Faculty of Medicine of Sousse, Sidi Bouzid, 9000, Tunisia 2 Emergency department, University of Sousse, Sidi Bouzid, 9000, Tunisia 3 Hospital of Sidi Bouzid, University of Sousse Faculty of Medicine of Sousse, Sidi Bouzid, 9000, Tunisia Amin Khbou Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Samia Meherzi Roles: Conceptualization, Validation, Visualization Amal Hammami Roles: Validation, Visualization Oumaima Hamdani Roles: Conceptualization, Data Curation, Formal Analysis, Methodology, Resources, Validation, Visualization, Writing – Original Draft Preparation Marwa Telmoudi Roles: Validation, Visualization Anis Kerkeni Roles: Validation, Visualization Islem Dakhli Roles: Validation, Visualization OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Tuberculosis of the parotid is an uncommon presentation, as the gland is rarely a primary site of infection. It is often confused with malignant tumors because of the similarity of the clinical presentation (the presence of a progressive and abscessed parotid swelling) We present the case of a 4-year-old girl who presented with chronic indurated right parotid gland swelling evolving from one month with fever. Clinical examination objectified a painful, indurated right parotid mass measuring 7 cm with ipsilateral grade 2 right peripheral facial palsy. Imaging showed a solid-cystic parotid mass with lysis of the mandibular condyle. Malignancy was suspected. However, biopsy confirmed tuberculosis. Pulmonary tuberculosis was ruled out. The patient responded well to anti-tuberculosis therapy, showing significant improvement after six months. Parotid gland tuberculosis is very rare and can mimic malignant tumors. It is crucial to rule out this diagnosis, especially in countries where tuberculosis is common, during the diagnosis process. READ ALL READ LESS Keywords tuberculosis, parotid gland, anti tubercular agents Corresponding Author(s) Amin Khbou ( [email protected] ) Close Corresponding author: Amin Khbou Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Khbou A et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Khbou A, Meherzi S, Hammami A et al. Case Report: Parotid Tuberculosis: About a Case Report Mimicking a Tumoral Origin in a Child [version 1; peer review: 1 approved] . F1000Research 2025, 14 :1047 ( https://doi.org/10.12688/f1000research.169355.1 ) First published: 06 Oct 2025, 14 :1047 ( https://doi.org/10.12688/f1000research.169355.1 ) Latest published: 06 Oct 2025, 14 :1047 ( https://doi.org/10.12688/f1000research.169355.1 ) Introduction Tuberculosis is a granulomatous disease caused by Mycobacterium tuberculosis or Mycobacterium bovis. Although pulmonary involvement remains the most common form, extra-pulmonary tuberculosis accounts for 20% of cases. 1 Involvement of the salivary glands, particularly the parotid gland, is extremely rare. Clinically, Parotid tuberculosis usually presents as a unilateral swelling of the parotid gland. 2 The absence of distinctive clinical, radiological, or biological indicators often leads to a mimicry of various neoplastic conditions, making the diagnosis especially challenging. Histopathological and microbiological assessments are therefore key components of the diagnostic process. 3 Early recognition is crucial to avoid misdiagnosis and inappropriate management, especially in endemic areas. This case report highlights a rare presentation of parotid gland tuberculosis in a child, initially suspected to be a tumoral origin. Case report The case involved a 4-year-old girl from a rural region, belonging to a family of modest socio-economic status, having neither a previous medical history nor a family history of malignant tumors. She had no known contact with tuberculosis. She was presented by her parents to the otorhinolaryngology clinic with a right parotid swelling that had been evolving over one month. The swelling was accompanied with low-grade fever but no night sweats, weight loss, or signs of systemic illness. Following her admission to the otorhinolaryngology department, a detailed clinical examination was conducted for the patient which revealed a right parotid swelling measuring 7 cm long. The overlying skin showed mild inflammatory changes, but no fistula or discharge were observed. On palpation, the swelling was warm, painful and indurated, with central fluctuation. Grade II right-sided peripheral facial nerve palsy was also identified. No cervical lymphadenopathy was palpable upon examination, and the rest of the clinical assessment was unremarkable ( Figure 1 ). Figure 1. A 4 year-old female child with parotid swelling. Initial laboratory tests indicated systemic inflammation. Within 24 hours, a contrast-enhanced CT scan revealed a solid cystic mass in the right parotid gland, measuring 44 x 66 mm, poorly defined with heterogeneous contrast. Partial lysis of the right mandibular condyle was observed, without extension to the deep cervico-facial spaces ( Figure 2 : a,b,c). Figure 2. CT scan (a: Axial, c: Coronal) A solid-cystic mass in the right parotid gland, with poorly defined limits and heterogeneous contrast enhance. Partial lysis of the right mandibule (b: bone, axial). The induration of the swelling, the facial paralysis and the bone lysis observed on CT scan were raising concern for malignancy. On the third day of hospitalization, the patient underwent a surgical incision and drainage procedure under local anesthesia. Purulent material was obtained for bacteriological culture, and a biopsy of the lesion margins was performed for histopathological evaluation. Both samples (pus and biopsy) confirmed the tuberculous origin of the swelling, with no evidence of malignancy. A chest X-Ray was subsequently conducted, which ruled out pulmonary involvement. On hospital day seven, following baseline assessments that included liver and renal function tests and an ophthalmological examination, a standard anti-tuberculosis treatment regimen was initiated, adjusted according to the patient’s weight and age. The protocol consisted of two months of quadruple therapy (Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol) followed by four months of dual therapy (Rifampicin and Isoniazid). During hospitalization, the patient was monitored for treatment tolerance and exhibited no adverse reactions. Over the subsequent weeks, clinical improvements were observed, including a reduction in parotid swelling and progressive recovery of facial nerve function. Seven days after starting treatment, the patient was discharged with monthly follow-up appointments and successfully completed the full six-month course of therapy, resulting in favorable outcomes. Discussion The handling of this rare pediatric case highlights effective clinical management through a systematic, multidisciplinary diagnostic approach that emphasized histopathological confirmation before treatment. The team avoided premature surgery despite radiological signs of malignancy, leading to full recovery and preserved facial nerve function. However, limitations included the lack of advanced microbiological diagnostics (PCR and GeneXpert) which could have expedited confirmation. Also, the absence of long-term follow-up, hindering the evaluation of recurrence or late complications. As with all single-case reports, the findings should be viewed carefully regarding their extensive application. Although tuberculosis is an infectious disease that mainly affects the lungs, it can affect any organ in the body. 4 However, even in endemic countries where the disease is widespread, tuberculous involvement of the parotid gland remains extremely rare. 5 In children, this location is even more unusual, which can delay the diagnosis. 6 In our patient’s case, the clinical presentation initially evoked a suppurative infectious etiology. However, the chronic course over the last 1 month did not support an acute infectious suppurative etiology. This suggests an inflammatory or tumoral etiology. 7 It is wise to rule out a tumoral pathology of the parotid gland, due to the unilaterality, induration of the swelling, facial paralysis, and bone lysis observed on CT. Indeed, malignant tumors of the parotid gland, such as mucoepidermoid or cystic adenoid carcinomas, can present in a similar manner. 8 Imaging plays an important role in diagnosis guidance. CT scans provide a detailed exploration of the parotid gland, with greater sensitivity than ultrasound. However, the radiological features observed are not specific to tuberculosis. According to the literature, the most frequently observed appearance is: thick-walled, contrast-enhanced lesion with central necrosis, characteristic of tuberculosis. Nevertheless, different aspects can be observed, such as homogeneous enhancement of the parotid gland, homogeneous enhancement with a non-enhanced microcyst, or isolated or confluent hypodense nodular lesions. 9 Bacteriological examination and histopathological study were essential to confirm tuberculosis. The presence of acid-fast bacilli in the specimens, as well as epithelioid granulomas with caseous necrosis observed histologically, are characteristic of tuberculosis. 10 For parotid tuberculosis, the treatment regimen is the standard extra-pulmonary tuberculosis regimen: two months of quadruple therapy (Rifampicin, Isoniazid, Pyrazinamide and Ethambutol) followed by dual therapy (Rifampicin and Isoniazid). 11 Treatment lasts 6 months. Regular monitoring is essential to assess the efficiency of the anti-tuberculosis treatment, ensure that the patient is following it correctly, and take action rapidly if side effects appear. Patient education is therefore crucial. 11 The effectiveness of the treatment is assessed on the basis of the clinical course and various additional tests (biology, imaging, etc.) deemed necessary by the treating physician. 11 Despite the lack of formal staging system for extrapulmonary tuberculosis of the parotid gland. But several clinical features in this case were important for predicting how the disease would progress. A positive outcome was the result of early diagnosis, absence of immunosuppression and good adherence to therapy. 12 From the family’s perspective, the uncertainty and fear of malignancy were a major source of anxiety. They felt a sense of relief upon receiving a clear and treatable diagnosis. Opting for a non-surgical approach, along with progressive recovery of facial function, not only alleviated their concerns but also strengthened their confidence in the healthcare team. Conclusion This case highlights the importance of considering a wide range of differential diagnosis, including tuberculosis, when faced with parotid swelling in children, especially in endemic regions. Multidisciplinary management, including appropriate investigations and well-administered anti-tuberculosis treatment, is essential to ensure a favorable prognosis. Although parotid tuberculosis is rare, it should be considered in order to avoid delays in diagnosis and treatment, which could have serious consequences for the patient. Consent for publication Written Informed Consent from the patient’s legally authorized representative for the publication of this case report. Ethical approval and consent to participate Our institution does not require ethical approval for reporting individual cases or case series. Written Informed Consent from the patient’s legally authorized representative for the publication of this case report. Data availability statement Zenodo: Underlying dataset for “Parotid Tuberculosis: A Case Report Mimicking a Tumoral Origin in a Child”. https://doi.org/10.5281/zenodo.17136085 This project contains the following underlying data: • The manuscript. • Clinical_Images: photo showing the parotid swelling and related facial features (external appearance). • Imaging_CT_Scans: CT scan slices corresponding slices used in the diagnosis. Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). The datasets generated and/or analyzed during the current study are not publicly available due to patient confidentiality and ethical concerns. However, data may be made available upon reasonable request. Researchers who meet the criteria for access to confidential data can obtain the data by contacting the corresponding author: Dr Amin Khbou. M. D, Faculty of medecine of Sousse, Email: [email protected] . Acknowledgement The authors would like to thank Dr Mohamed Jlidi for his kind assistance in the elaboration of this article. References 1. Myer C, Cotton RT: Salivary Gland Disease in Children: A Review: Part 1: Acquired Non-Neoplastic Disease. Clin. Pediatr. (Phila). 1986; 25 : 314–322. Publisher Full Text 2. Garg R, Verma SK, Mehra S, et al. : Parotid tuberculosis. Lung India. 2010; 27 : 253–255. PubMed Abstract | Publisher Full Text | Free Full Text 3. Gupta N, Aggarwal A, Tripathi M, et al. : Parotid gland tuberculosis. QJM: An International Journal of Medicine. 2020; 113 : 500–501. Publisher Full Text 4. Yang F, Wu M, Peng Y, et al. : Do Not Ignore Tuberculosis of the Parotid Gland When Meeting Obvious Infiltration of Neutrophils in a Suspicious Swelling by FNAC. Ear Nose Throat J. 2022; 101 : NP266–NP269. PubMed Abstract | Publisher Full Text 5. Agrawal A, Chandermani, Gathwal M, et al. : Tubercular sialadenitis of parotid gland - An extremely rare case series. Indian J. Tuberc. 2016; 63 : 262–264. PubMed Abstract | Publisher Full Text 6. Ramesh Bhat Y, Kini S, Prakashini K: Rare case of tubercular parotid abscess. BMJ Case Rep. 2021; 14 : e237491. PubMed Abstract | Publisher Full Text | Free Full Text 7. Wilson KF, Meier JD, Ward PD: Salivary gland disorders. Am. Fam. Physician. 2014; 89 : 882–888. 8. Deffay M: Tumeurs de la glande parotide. EM-Consulte (Elsevier Masson). 2023; 20-629-A-10. 9. Benhammou A, El Ayoubi A, Benbouzid M-A, et al. : Tuberculose primaire de la glande parotide. Arch. Pediatr. 2007; 14 : 1206–1209. PubMed Abstract | Publisher Full Text 10. Chouai M, Lachkar A, Tsen AA, et al. : Tuberculose parotidienne: un diagnostic oublie, à propos de 2 cas et revue de littérature. Pan Afr. Med. J. 2018; 29 : 203. 11. Belatik H, Aouinti L, Touiheme N, et al. : Histological surprise of parotid tuberculosis: about two cases. Pan Afr. Med. J. 2019; 32 : 85. 12. Haque G, Kumar A, Saifuddin F, et al. : Prognostic Factors in Tuberculosis Related Mortalities in Hospitalized Patients. Tuberculosis research and treatment. 2014; 2014 : 1–6. PubMed Abstract | Publisher Full Text | Free Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 06 Oct 2025 ADD YOUR COMMENT Comment Author details Author details 1 ENT department, University of Sousse Faculty of Medicine of Sousse, Sidi Bouzid, 9000, Tunisia 2 Emergency department, University of Sousse, Sidi Bouzid, 9000, Tunisia 3 Hospital of Sidi Bouzid, University of Sousse Faculty of Medicine of Sousse, Sidi Bouzid, 9000, Tunisia Amin Khbou Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Samia Meherzi Roles: Conceptualization, Validation, Visualization Amal Hammami Roles: Validation, Visualization Oumaima Hamdani Roles: Conceptualization, Data Curation, Formal Analysis, Methodology, Resources, Validation, Visualization, Writing – Original Draft Preparation Marwa Telmoudi Roles: Validation, Visualization Anis Kerkeni Roles: Validation, Visualization Islem Dakhli Roles: Validation, Visualization Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 06 Oct 2025, 14:1047 https://doi.org/10.12688/f1000research.169355.1 Copyright © 2025 Khbou A et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Khbou A, Meherzi S, Hammami A et al. Case Report: Parotid Tuberculosis: About a Case Report Mimicking a Tumoral Origin in a Child [version 1; peer review: 1 approved] . F1000Research 2025, 14 :1047 ( https://doi.org/10.12688/f1000research.169355.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 06 Oct 2025 Views 0 Cite How to cite this report: Mocanu H. Reviewer Report For: Case Report: Parotid Tuberculosis: About a Case Report Mimicking a Tumoral Origin in a Child [version 1; peer review: 1 approved] . F1000Research 2025, 14 :1047 ( https://doi.org/10.5256/f1000research.186689.r425517 ) The direct URL for this report is: https://f1000research.com/articles/14-1047/v1#referee-response-425517 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 07 Nov 2025 Horia Mocanu , “Titu Maiorescu” University, Bucharest, Romania Approved VIEWS 0 https://doi.org/10.5256/f1000research.186689.r425517 (A) The article provides data on a very interesting case, of which there are only a few. We personally have not had experience with parotid localization of TB. As such, the case presentation proves very useful and should without ... Continue reading READ ALL (A) The article provides data on a very interesting case, of which there are only a few. We personally have not had experience with parotid localization of TB. As such, the case presentation proves very useful and should without question be published, especially since it deals with a pediatric patient. The avoidance of premature surgery despite a confusing clinical picture and the multidisciplinary treatment may also be very useful as presentations and conclusion for the medical community. The diagnosis confusion with other tumors is also a key point of the case. (B) Introduction and discussion This subject is rarely present in literature and we consider a significant number of the important published studies have been properly cited. All in all, the work is original by its subject alone and therefore worthy of publication. (C) Materials and methods The work is well presented and we would like to congratulate the authors for it. The methodology (case report) appears to be sound and does not require any other controls at this time. The therapeutic protocol follows WHO indications. A comparison to other similar studies may also prove useful for the discussion, although we acknowledge the rarity of the localization. (D) Results The data presented is substantial, with good and viable results. We consider the work solid and original in concept and practice, and the case novel and interesting. (E) Quality of English language The paper is written in a clear, cursive, and correct English language and all the scientific terms are correctly used. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: ENT&HNS I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Mocanu H. Reviewer Report For: Case Report: Parotid Tuberculosis: About a Case Report Mimicking a Tumoral Origin in a Child [version 1; peer review: 1 approved] . F1000Research 2025, 14 :1047 ( https://doi.org/10.5256/f1000research.186689.r425517 ) The direct URL for this report is: https://f1000research.com/articles/14-1047/v1#referee-response-425517 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 24 Nov 2025 Amin Khbou , ENT department, University of Sousse Faculty of Medicine of Sousse, Sidi Bouzid, 9000, Tunisia 24 Nov 2025 Author Response Thank you, Dr., for your approval of this work Competing Interests: We have no competing interests Thank you, Dr., for your approval of this work Thank you, Dr., for your approval of this work Competing Interests: We have no competing interests Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 24 Nov 2025 Amin Khbou , ENT department, University of Sousse Faculty of Medicine of Sousse, Sidi Bouzid, 9000, Tunisia 24 Nov 2025 Author Response Thank you, Dr., for your approval of this work Competing Interests: We have no competing interests Thank you, Dr., for your approval of this work Thank you, Dr., for your approval of this work Competing Interests: We have no competing interests Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 06 Oct 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 1 06 Oct 25 read Horia Mocanu , “Titu Maiorescu” University, Bucharest, Romania Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Mocanu H. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The author(s) is/are employees of the US Government and therefore domestic copyright protection in USA does not apply to this work. The work may be protected under the copyright laws of other jurisdictions when used in those jurisdictions. 07 Nov 2025 | for Version 1 Horia Mocanu , “Titu Maiorescu” University, Bucharest, Romania 0 Views copyright © 2025 Mocanu H. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The author(s) is/are employees of the US Government and therefore domestic copyright protection in USA does not apply to this work. The work may be protected under the copyright laws of other jurisdictions when used in those jurisdictions. format_quote Cite this report speaker_notes Responses (1) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions (A) The article provides data on a very interesting case, of which there are only a few. We personally have not had experience with parotid localization of TB. As such, the case presentation proves very useful and should without question be published, especially since it deals with a pediatric patient. The avoidance of premature surgery despite a confusing clinical picture and the multidisciplinary treatment may also be very useful as presentations and conclusion for the medical community. The diagnosis confusion with other tumors is also a key point of the case. (B) Introduction and discussion This subject is rarely present in literature and we consider a significant number of the important published studies have been properly cited. All in all, the work is original by its subject alone and therefore worthy of publication. (C) Materials and methods The work is well presented and we would like to congratulate the authors for it. The methodology (case report) appears to be sound and does not require any other controls at this time. The therapeutic protocol follows WHO indications. A comparison to other similar studies may also prove useful for the discussion, although we acknowledge the rarity of the localization. (D) Results The data presented is substantial, with good and viable results. We consider the work solid and original in concept and practice, and the case novel and interesting. (E) Quality of English language The paper is written in a clear, cursive, and correct English language and all the scientific terms are correctly used. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise ENT&HNS I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (1) Author Response 24 Nov 2025 Amin Khbou, ENT department, University of Sousse Faculty of Medicine of Sousse, Sidi Bouzid, 9000, Tunisia Thank you, Dr., for your approval of this work View more View less Competing Interests We have no competing interests reply Respond Report a concern Mocanu H. Peer Review Report For: Case Report: Parotid Tuberculosis: About a Case Report Mimicking a Tumoral Origin in a Child [version 1; peer review: 1 approved] . F1000Research 2025, 14 :1047 ( https://doi.org/10.5256/f1000research.186689.r425517) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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