Primary Peritonsillar Tuberculosis in a Rheumatoid Arthritis Patient Treated With Methotrexate.

A 48-year-old man diagnosed with rheumatoid arthritis was treated with methotrexate for 10 years. He presented left tonsil ulceration and ipsilateral cervical lymphadenopathy. A tonsillar biopsy revealed tuberculosis. The patient received antituberculous therapy for 8 months with a positive response. However, after resumption of methotrexate due to worsening rheumatoid arthritis, symptoms recurred. The patient initiated antituberculous therapy once more for 6 months, and methotrexate was stopped. At regular follow-up, the patient showed a positive clinical response with resolution of tonsillar ulceration and lymphadenopathy after 14 months of antituberculosis treatment.