<p>When intraparotid lymph nodes within the parotid gland enlarge pathologically, it poses special diagnostic challenges. Granulomatous lymphadenitis, especially from tuberculosis, is a significant but uncommon differential diagnosis among the many causes of parotid region masses. It may resemble benign or malignant salivary gland neoplasms both clinically and radiologically. Here, we describe a male patient, age 28, who had a painless swelling in the left parotid area. Multiple enlarged lymph nodes without a fatty hilum were seen on imaging, which may indicate an infectious or neoplastic cause. Granulomatous lymphadenitis was confirmed by fine needle aspiration cytology (FNAC), which revealed well-formed epithelioid granulomas, multinucleated giant cells, lymphocytes, and focal necrosis. Although acid-fast bacilli were not detected by Ziehl–Neelsen staining, tuberculous aetiology was suspected, and microbiological correlation was advised. This case underscores the significance of FNAC in early diagnosis and differentiation from neoplasms, aiding in avoiding unnecessary surgical intervention. Histopathology remains the gold standard for diagnosis confirmation. The rarity of parotid tuberculosis, particularly in isolated forms, emphasizes the importance of considering granulomatous diseases in the differential diagnosis of salivary gland swellings.</p>