Oral tuberculosis

A Giant Nodule of the Soft Palate Mimicking a Tumor: A Case of Oropharyngeal Tuberculosis

Tuberculosis is an infectious disease caused by a bacterium called Mycobacterium tuberculosis. According to the World Health Organization, tuberculosis is the leading cause of death by an infectious disease worldwide. We describe here a rare case of tuberculosis that presented as a giant nodule of the soft palate mimicking a tumor. A 50-year-old man was admitted to the oral and facial surgery department for odynophagia and nocturnal snoring. The clinical examination of the oral cavity revealed a mass on the right side of the soft palate, pushing back the uvula on the left, measuring 3 cm in length, nodular in appearance, hard to palpate, and painless with no inflammatory sign of the mucosa opposite. A contrast-injected cervicofacial scan and magnetic resonance imaging were requested that showed a heterogeneous mass on the right side of the soft palate. The therapeutic decision was to perform a biopsy under general anaesthesia, with a histopathological study of the mass. Intraoperatively, the mass was detachable and completely removable. The definite histopathological examination of the surgical specimen was in favour of tuberculosis of the soft palate.

Oral tuberculosis: An unusual case report

Tubercular Lesions of oral cavity are relatively uncommon and are generally missed in the differential diagnosis before the systemic symptoms become evident. The purpose of this article is to know the varied presentation of tuberculosis in the oral cavity and also highlights the prime role of Oral Pathologist in making the diagnosis of this disease.

Atypical presentation of tuberculosis

Developing countries such as India face an intense situation with communicable diseases such as tuberculosis (TB). It is an inflammatory infectious granulomatous disease commonly affecting the lungs. Extrapulmonary TB presentations have been documented, with the orofacial region also being involved. TB usually presents as an ulcer in the oral cavity with tongue and lip being the favored sites. TB presenting as a lip swelling is unusual even if it is a secondary lesion with a primary pulmonary involvement. We present a lip swelling and discuss the differential diagnosis. Investigation of ultrasonography revealed a vascular lesion which was disproved, suggesting an increase in vascularity even in diseases such as TB. We present a case of a lip swelling which led to the diagnosis of recurrent pulmonary TB which the patient was unaware of. Findings of histopathology revealing the absence of bacilli are also discussed. Monetary constraints frequently cause a neglect of dangerous diseases such as TB.

Primary oral tuberculosis: A case series of a rare disease

Tuberculosis (TB) is still one of the most life-threatening infectious diseases, resulting in high mortality in adults and is commonly found in developing countries. Lung is primarily affected while extrapulmonary TB is rarely encountered. Oral lesions, although rare, can be seen in both primary and secondary stages of TB. Primary oral TB may present a diagnostic challenge as its clinical features can be nonspecific that mimics other diseases and is usually misdiagnosed. Thus, it is very important to be aware and be highly suspicious of oral TB especially in endemic area. We share 4 such cases of primary oral TB with uncommon presentations (two on the gingiva, one on the palate and one on the tongue) The diagnosis was made by histopathological examination, polymerase chain reaction analysis and Mantoux test. They were successfully treated with antituberculous treatment. In secondary TB, the oral manifestations may be accompanied by lesions in the lungs, lymph nodes or in any other part of the body and can be detected by a systemic examination.

A case report of a tongue ulcer presented as the first sign of occult tuberculosis

Background

Tuberculosis (TB) is a serious infectious disease with considerable fatality, typically affecting the pulmonary system and, rarely, other body organs including the oral cavity. Due to the rarity of oral TB, it is frequently overlooked in differential diagnosis of oral lesions. Despite a declining trend in TB incidence in recent years, it is still a major public health problem with high contagiousness, thereby requiring the early diagnosis and prompt treatment.

Case presentation

A 57-year-old male patient presented with chief complaint of painful ulcer on tip of his tongue. He reported that the ulcer developed without any remarkable event such as mechanical trauma, vesicle formation or systemic illness. His past medical history revealed the TB over 40 years ago, which had reportedly healed after pharmacological treatments. As the ulceration persisted after topical steroid application and careful education about avoiding possible mechanical stimuli, biopsy was performed and histological finding showed typical findings of oral tuberculosis including intense granulomatous inflammatory features with small red rods of mycobacterial organisms as well as epithelioid cells and Langhans giant cells. After suitable antituberculosis treatments, oral tuberculosis ulcer was almost completely healed. We present a case of oral TB affecting tip of the tongue in a patient with a history of pulmonary TB and emphasize the understanding of intraoral manifestations for early diagnosis and prompt treatment of TB.

Conclusions

The present case represented the importance of understanding oral tuberculosis manifestations for dental clinicians who might be frequently the first health care professionals to encounter various oral lesions.

Oral tuberculosis - Current concepts

Tuberculosis (TB) is a chronic infectious disease that can affect various parts of the body including the oral cavity. It primarily affects the lungs. TB bacilli can spread hematogenously to different parts of the body and this also involves maxilla or mandible. Although oral lesions are infrequent, they are crucial for the early diagnosis and interception of primary TB. Intercepting the disease early will limit the morbidity and mortality of the patients. It becomes the responsibility of the dentist to include TB in the differential diagnosis of suspicious oral lesions to prevent delay in the treatment of the disease. It would not be an exaggeration if the dental identification of the TB lesions has the potential of serving as a significant aid in the first line of control for this hazardous and often fatal disease. This article will also emphasize the advancing role of oral pathologists in making the final diagnosis of this dreaded disease.

Tubercular Ulcer of Tongue in an Elderly Patient Masquerading as a Traumatic Ulcer

Tuberculosis is still one of the most prevalent diseases in developing countries like Nepal. However, due to the effectiveness of DOTS therapy, vaccination, and education, the prevalence of tuberculosis has fallen in recent years. Although the pulmonary and extrapulmonary tuberculosis, especially the tubercular lymphadenitis, is still very common in our country, the tuberculosis of oral cavity is an uncommon condition. We present a case of an elderly male who presented with the complaint of nonhealing ulcer of lateral border of tongue for 2-month duration which was masquerading as a traumatic ulcer due to sharp teeth adjacent to the lesion. Deep biopsy was taken under local anesthesia. Histopathological examination revealed that it was tuberculosis. Antitubercular therapy was then started which cured the lesion.

Oral Mucosal Infections: Insights into Specimen Collection and Medication Management

Oral mucosal infections appear as localized or generalized lesions. Symptoms range from almost unnoticeable lesions to severe pain. Systemic disease, age, immunocompromised condition, and medication use are common causes. Local causes include dentures, poor oral hygiene, traumatized epithelium, ulcerations, dentures, implants, oral piercing, and reduced salivary secretion. Oral mucosal infections are underdiagnosed and microbiological diagnosis should be more frequently used. Candidiasis is most frequently diagnosed. Clinical appearances are not always clear and are varied, creating a diagnostic challenge. Thorough understanding of clinical appearance and updated information on diagnostic and therapeutic management are essential for successful patient outcome.

Case series of extra pulmonary tuberculosis presenting as facial swelling

In England there were 7,290 cases of tuberculosis (TB) reported in 2013. The area with the highest incidence of the disease in England is London, with hotspots in other urban areas. TB affecting the head and neck is rare. We present three such cases of TB presenting as pre-auricular swelling. Two of the patients were initially misdiagnosed as having dental infection, demonstrating the importance of taking a good history and considering the differential diagnosis of TB when appropriate. TB remains a potentially fatal disease that should be considered in patients presenting with facial swelling where common causes have been excluded.

Tuberculous Parotitis: Case Report and Literature Review

Objectives:

Our aim was to better understand the rarely encountered tuberculous (TB) parotitis.

Methods:

A case of TB parotitis is reported, and the literature is reviewed.

Results:

Forty-nine patients (27 men, 22 women; mean age, 38.3 ± 16.4 years) were enrolled. The median duration of symptoms before these patients sought medical help was 6 months. Except for 1 patient with bilateral TB parotitis, all had unilateral involvement; complications included draining sinuses in 4 patients (8%) and facial palsy in 2 patients (4%). Twenty-one of 36 patients (58%) had a painless parotid mass, 12 of 19 (63%) had cervical lymphadenitis, 8 of 11 (73%) had fever, and 11 of 44 (25%) had pulmonary tuberculosis (4 active and 7 inactive cases). Neoplasm was the most common presumptive diagnosis. The diagnosis of TB parotitis in most cases was made on the basis of cytologic analysis of the fine-needle aspirate or histopathologic analysis of the excised tissue. Forty-six patients with TB parotitis who had a traceable outcome survived after 6 to 10 months of antituberculosis chemotherapy.

Conclusions:

Physicians should have a high index of suspicion for TB parotitis in patients with a chronic parotid lump, even if the chest radiographs appear normal. Fine-needle aspiration should be performed first for diagnosis, and TB parotitis should be medically treated.

Orofacial tuberculosis: Clinical manifestations, diagnosis and management

Orofacial tuberculosis (TB) is an uncommon form of extrapulmonary TB and is nonspecific in its clinical presentation. It can be misdiagnosed especially when oral lesions are present before systemic symptoms become apparent. Doctors especially attending dentist who generally is the first among clinicians to come across such pathological entity should be aware of the orofacial lesions of TB and consider them in the differential diagnosis of suspicious oral lesions to ensure early diagnosis of TB and its treatment. In this review, we have discussed in detail the clinical presentation of various forms of orofacial TB, diagnosis, and management of patients. Also, an update is provided about recent anti-TB drug development.

Tuberculosis of the oral cavity: an uncommon but still a live issue

This paper aims at characterizing clinical features, occurrence, diagnostic process and treatment of oral tuberculosis (TB), basing on the available literature. Oral TB manifestations are uncommon and usually secondary to pulmonary changes. They predominantly appear as ulcers. Eruptions are usually single, painful and resistant to conventional treatment. Diagnosis always needs to be confirmed histopathologically. Anti-tubercular systemic therapy is required in every patient diagnosed with oral TB, while topical treatment is only adjuvant. A low incidence of oral TB together with a non-specific clinical picture might pose difficulties in its diagnosis. Oral changes in TB are likely to be overlooked what can result in further spread of Mycobacterium tuberculosis due to a delay in instituting proper treatment. Tuberculosis morbidity has risen recently and more multi-drug resistant strains of TB bacilli are found, what can result in a higher incidence of oral TB. Clinicians should be therefore aware of a possible occurrence of this entity and consider it while making a differential diagnosis of atypical oral changes.

Oral ulcer: an uncommon site in primary tuberculosis

Tuberculosis is a chronic infectious disease and a major cause of morbidity and mortality worldwide. It can affect any part of the body, including the oral cavity. Oral lesions of tuberculosis, though uncommon, have been observed in both primary and secondary stages of the disease. This article presents a case of primary tuberculosis manifested as a non-healing, tender ulcer on the lingual mucosa of the edentulous right mandibular arch molar zone, an uncommon site. The diagnosis was confirmed after histopathology examination, polymerase chain reaction and purified protein derivative tests and chest radiograph. A recommended treatment plan of six months with four anti-tuberculotic antibiotics was commenced. Clinically, the oral ulcer disappeared three months after the commencement of treatment. The resurgence of tuberculosis should compel clinicians to include the disease in the differential diagnosis of various types of non-healing oral ulcers.

Tuberculosis: oral alveolus and pulmonary alveoli coexisting

Tuberculosis of the oral cavity is uncommon in this antibiotic era. We report a case of a long standing non-healing ulcer of the right upper maxillogingival sulcus, found to be tuberculosis of a rather unusual site in the oral cavity, the alveolus.

Primary tuberculous gingival enlargement - A rare clinical entity: Case report and brief review of the literature

Tuberculosis (TB) is a chronic specific granulomatous disease and a major cause of death in developing countries. The clinical presentation of TB lesions of the oral cavity varies widely and can manifest as ulcerations, diffuse inflammatory lesions, granulomas and fissures. Oral lesions generally appear secondary to primary TB infection elsewhere, although primary infection of the oral mucosa by Mycobacterium tuberculosis has also been described. We hereby report a case of primary TB of the gingiva manifesting as gingival enlargement. Diagnosis was based on histopathological examination, complete blood count, X-ray chest and immunological investigations with detection of antibodies against M. tuberculosis. Anti-tuberculous therapy was carried out for over 6 months and was followed by surgical excision of the residual enlargement under local anesthesia. After 1-year follow-up, there was no recurrence of the disease. This case report emphasizes the need for dentists to include TB in the differential diagnosis of various types of gingival enlargements.

Primary tuberculosis in soft palate: case report of a rare entity

A 40-year-old male patient presented to our clinic with history of dysphagia and ulceration in the palate for two months. After history-taking and thorough clinical examination, investigations like routine blood parameters, chest skiagram, sputum for acid-fast bacilli, ultrasonography of the abdomen, and biopsy from the palatal lesion were performed. No evidence in support of pulmonary or abdominal tuberculosis was found. Histopathological examination of the biopsy revealed granulomatous inflammation with Langhans giant cells and caseation necrosis. Diagnosis of primary tuberculosis of soft palate was made. Anti- tubercular regimen (CAT I) for 6 months was prescribed, and we got a dramatic response noted within 15 days. As isolated tuberculosis of soft palate is a very rare entity, one should, therefore, consider it in any case of chronic ulcer of the soft palate. Response to CAT 1 was excellent in our case.

Tubercular ulcer: mimicking squamous cell carcinoma of buccal mucosa

Tuberculosis is a chronic granulomatous disease that rarely affects oral cavity. Tuberculous lesions of the oral cavity are frequently overlooked in the differential diagnosis of oral lesions. The oral clinical presentation of tuberculosis may take many forms as ulcers, nodules, tubercular fissure, tubercular papilloma and tuberculomas. Diagnosis is confirmed by histopathology.

14th International Congress IAOP/AAOMP Clinical Pathology Conference Case 6

The clinicopathologic features of oral cryptococcosis manifested as multifocal tumor-like lesions located in the upper and lower gingival tissues of a 36-year-old male patient with AIDS are described. The gingival lesions were the initial manifestation of disseminated cryptococcosis from which central nervous system involvement was established. Clinical differential diagnosis and histopathologic features are discussed. Effect of treatment on the gingival lesions after 18 months follow-up is presented.

Orale Manifestation einer miliaren Tuberkulose

CASE REPORT

We report on the clinical course of a 40-year-old patient with an oral manifestation of miliary tuberculosis. In addition to oral mucosa and lung, the colon and ileum were also infested. The oral lesions may resemble malignant tumors and are difficult to diagnose, especially because tuberculosis has become a rare disease in industrialized countries.

DISCUSSION

Oral lesions and concomitant pulmonary complaints can be a sign for existing tuberculosis. Patients with these problems should undergo a chest X-ray and a biopsy from the oral mucosa. In addition, tests should be conducted to determine if mycobacteria are present in the sputum, gastric fluid, and urine and cultures grown. In cases with negative results PCR may detect DNA of Mycobacterium tuberculosis.

Oral mucosal ulceration

BACKGROUND

Tuberculosis, or TB, is a chronic infectious disease that can affect any part of the body, including the mouth. Oral lesions may be the only finding of primary pulmonary TB, in which case proper diagnosis by dentists is vital.

CASE DESCRIPTION

The authors present a case in which the patient sought treatment for a painful oral lesion. A histopathologic examination revealed characteristics of TB. Subsequently, pulmonary lesions were detected, and a diagnosis of pulmonary TB was confirmed. The patient underwent antituberculosis therapy, and his oral and systemic conditions improved rapidly.

CLINICAL IMPLICATIONS

Although oral manifestations of TB are rare, clinicians should be aware of their possible occurrence in their patient populations. Such awareness can help diagnose TB at an early stage, thereby preventing complications and potential contaminations.