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Abstract
[...]isolated involvement of the hypoglossal nerve is rarely reported and is a diagnostic challenge in clinical practice due to its diverse etiologies. {Figure 1} All routine blood investigations along with viral serology, serum vasculitis markers, angiotensin converting enzyme, and venereal disease research laboratory (VDRL) rapid plasma reagin (RPR) test were within normal range. On microscopic examination, the sample had degenerated polymorphs, histiocytes, along with well-defined clusters of epitheloid cells and lymphocytes with granuloma formation, lying in a necrotic background [Figure 3]a and [Figure 3]b. On staining, acid-fast bacilli were seen in the sample [Figure 3]c.{Figure 2}{Figure 3} Follow-up MRI scan after 3 months [Figure 4] showed significant regression in the bulk and extension of the soft tissue lesion compared to that seen on the previous MRI. [...]TB which is endemic in our geographical region must be considered as a differential diagnosis of neck and spinal pain in a suitable setting.