Tehran University of Medical Sciences Iranian Journal of Microbiology 2008-3289 11 6 2019 12 29 542 545 Seyyed Jafar Motahari Clinical Research Development Unit of Bou-Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran Parvaneh Afshar Research and Development of Referral Laboratory, Deputy of Health Management, Mazandaran University of Medical Sciences, Sari, Iran Maryam Ghasemi Department of Pathology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran Lale Vahedi Larijani Department of Pathology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran AND Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran Somayeh Sheidaei Department of Pathology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran 2019 08 29 2019 11 15 Primary tonsillar tuberculosis is an uncommon entity and a diagnostic challenge. Misdiagnosis can be prevented with early professional para-clinical finding. The true diagnosis is often delayed and infection management depends on recognizing disease patterns and early laboratory documentation. This rare clinical caseation granuloma with positive clinical symptoms, negative results of radiology/laboratory and alone based on histopathological finding without any Mycobacterium particle indicates the role of an accurate laboratory/pathology finding for urgent medical intervention treatment and lifesaving of patients, particularly in immunocompromised group. https://ijm.tums.ac.ir/index.php/ijm/article/view/2311 https://ijm.tums.ac.ir/index.php/ijm/article/download/2311/1212