25th November 2011, Volume 124 Number 1346

Tapan D Bairagya, Sibes K Das, Dilip C Barman, Somnath Bhattacharya

A 46-year-old non smoker, non-diabetic man presented to us complaining of an ulcer in the mouth which had been present for the last 6 months and was gradually increasing in size. Oral cavity examination revealed a single discrete ulcer of less than 1 cm in diameter present on the left buccal mucosa. The ulcer was bordered by ill-defined margins around which were several small ridges like swellings. On palpation, the ulcer was tender with indurated margins (Figure1). There was no cervical lymphadenopathy.

Systemic examination was unremarkable. His serology for HIV was negative. Incisional biopsy was taken from the edge of the ulcer. The histopathology showed multiple confluent and discrete granulomas composed of epithelioid histiocytes and Langhans giant cells and having no evidence of malignancy (Figure 2).

Mantoux test was positive (23 mm × 20 mm) with 1TU PPD. Sputum smear for acid-fast bacilli was negative. Chest X-ray (PA View) was normal. We started anti-tuberculous therapy with WHO Category – I regimen.

Six months later at follow up, the oral ulcer had healed with some fibrosis.

Figure 1. Oral cavity showing ulcer over the left buccal mucosa (A), before treatment; (B), after 6 months of antituberculous drug intake

(A)

(B)

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Bairagya-2

Figure 2. Histopathology of the biopsy material showing multiple confluent and discrete granulomas composed of epithelioid histiocytes and Langhans giant cells (H&E stain, ×100)

Bairagya-3

Discussion

Differential diagnosis of granulomatous ulcer of the oral mucosa are tuberculosis, sarcoidosis, fungal infection, Wegener’s granulomatosis, foreign body granuloma etc. The primary occurrence of oral tuberculosis is very uncommon. The presenting symptoms of oral tuberculosis are ulceration, swelling, cervical lymphadenitis, fever, focal pain, nonhealing extraction wound. Most common presentation is ulceration.1

Oral tuberculosis usually coexists with pulmonary disease. Primary oral tuberculosis can occur in any age group. It usuallyinvolves the gingiva, mucobuccal folds, inflammatory foci adjacentto teeth or extraction sites, and it often is associated withenlarged cervical lymph nodes.2

Whether primary or secondary oral tuberculosis, early detection, diagnosis, and treatment are the utmost importance.

Author Information

Tapan D Bairagya, RMO cum Clinical Tutor, Department of Respiratory Medicine; Sibes K Das, Associate Professor. Department of Respiratory Medicine; Dilip C Barman, Assistant Professor, Department of Pathology; Somnath Bhattacharya, Assistant Professor, Department of Respiratory Medicine; North Bengal Medical College, Darjeeling, West Bengal, PIN- 734012 ,India

Correspondence

Tapan D Bairagya, Department of Respiratory Medicine, North Bengal Medical College, PO Box – 734012, Darjeeling, West Bengal, India.

Correspondence Email

tdasbairagya@gmail.com

References

  1. Wang WC, Chen JY, Chen YK, Lin LM. Tuberculosis of the head and neck: a review of 20 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endo. 2009;107:381-6.
  2. Hathriam BT, Grewal DS, Irani DK, et al. Tuberculoma of the cheek: a case report. J Laryngol Otol 1997;111:872–3.