Primary Lingual Tuberculosis in Immunocompetent Patient: a Case Report

Abstract

Oral manifestations of tuberculosis are quite rare with an incidence rate of 1.4%. The tongue is the most common site of oral tuberculosis having varied presentations. Lingual tuberculosis is a diagnostic dilemma because of its rarity, particularly in immunocompetent patients. We are reporting a rare case of primary tuberculosis of the tongue in a 38 year old male diagnosed on fine needle aspiration cytology.

Multiple oral ulcers leading to diagnosis of pulmonary tuberculosis

“…Systemic factors include lowered host resistance and increased virulence of the organisms. [ 4 7 ] Local factors comprises poor oral hygiene, local trauma, chronic inflammation, tooth eruption, extraction sockets, periodontal disease, carious teeth with pulp exposure[ 7 ] and presence of lesions like leukoplakia, dental cysts, dental abscesses, and jaw fractures. Any breach in the mucosal lining predisposes toward oral involvement.…”

“…Ulcers apart, tubercular tongue lesions present as tuberculoma, tuberculous fissure, tubercular papilloma, diffuse glossitis, or atubercular cold abscess. [ 7 ] The dorsal surface of the tongue is more commonly involved. [ 3 ]…”

Oral Tuberculosis: A Rare Manifestation of Disseminated Disease in a Patient with Dermatomyositis on Chronic Corticosteroids

“…Additionally, the epithelium of the oral mucosa serves as a natural barrier to infection. Therefore, tuberculosis of the oral cavity rarely occurs as primary disease and often arises secondary to infected respiratory secretions or hematogenous dissemination from pulmonary involvement [4–7]. Trauma, as the patient reported in this case, or inflammation of an area in the oral cavity due to smoking may serve as a predisposing factor for either primary or secondary disease [4].…”

Oral tuberculosis following successful treatment of oral malignancy

“…[4] Involvement of the oral cavity is exceedingly rare and there is limited English literature published on this. [5] The natural resistance conferred by the intact mucous membrane prevents the direct penetration by bacilli. Various reasons for the sparse levels of mycobacteria in the oral cavity are the cleansing effects of saliva, the relatively lesser lymphoid tissue, and the antagonist oral commensals.…”