Oral tuberculosis is rare. We report a case of a patient with oral tuberculosis in the lower gingiva. The patient was an 83-year-old woman with no previous history of tuberculosis. Her chief complaint was a refractory ulcer of the mandibular gingiva expanding over a period of 11 months. The surface of the ulcer was granular, without induration, and part of the mandibular bone was exposed. CT showed a slightly enhanced area coinciding with the ulcer. T-spot blood test was positive. Tuberculosis was suspected, and she was referred to the Department of Infectious Diseases. Chest CT did not indicate pulmonary tuberculosis, but an acidophilic bacterium test returned positive for both Ziehl-Neelsen staining by direct smear examination and culture inspection. In addition, Mycobacterium tuberculosis was identified through PCR. She was diagnosed with tuberculosis, and treatment using rifampicin, isoniazid, and ethambutol was started. A gingival biopsy was performed after sputum examinations returned negative three times. Pathologically, the granuloma was composed of caseous necrosis surrounded by Langhans giant cells, epithelioid cells and infiltration of lymphocytes, which lead to a final diagnosis of oral tuberculosis. The ulcer healed after two months of chemotherapy. Medication was continued for one year, and there was no recurrence. Key words: oral tuberculosis (口腔結核) ,tuberculous ulcer (結核性潰瘍) ,mandibular gingiva (下顎歯肉) , Langhans giant cell (Langhans 型巨細胞) ,epithelioid cell granuloma (類上皮細胞肉芽腫) 1) 愛媛労災病院歯科口腔外科 (主任:千葉晃義部長) 2) 九州大学大学院歯学研究院口腔顎顔面病態学講座 口腔顎顔面外科学分野 (主任:森 悦秀教授) 3) 九州大学大学院歯学研究院口腔顎顔面病態学講座 口腔病理学分野 (主任:清島 保教授)
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