Tuberculoma of the Tongue Presenting as Hemimacroglossia

Abstract

The underdiagnosis of extrapulmonary tuberculosis lesions, along with an emerging global resistance to antitubercular drugs, warrants an increased awareness of the involvement of Mycobacterium tuberculosis in atypical lesions of oral cavity. Tongue is the most common site of oral tuberculosis. We report a rare presentation of lingual tuberculosis in a 65-year-old male, a chronic tobacco chewer, who came to us with swelling of the tongue which apparently looked like hemimacroglossia, leading to the clinical diagnosis of submucosal carcinoma of tongue. Enlargement of tongue is a slow process resulting from gradual invasion and lodging of bacilli in the tongue. Biopsy and histopathological examination revealed tuberculous etiology of the lesion and the patient responded well to antitubercular therapy.

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

“…Pathological lesions in oral TB may occur at any mucosal site [ 1 , 9 ]. It is reported that they are most commonly found on the tongue, followed by the labial mucosa (often at the labia contact site), hard palate, gingivae and buccal mucosa, as to the frequency [ 2 , 6 , 13 , 15 , 18 , 26 – 30 ]. Kakisi et al .…”

“…This form of the disease usually appears in children, whereas the secondary form is most commonly observed in the middle-aged and elderly [ 7 , 17 , 27 , 31 ]. Ulcerations in the secondary TB cause profound pain [ 4 , 15 , 20 , 25 , 27 , 31 ]. Painful changes may interfere with speech and food ingestion, and often cause hypersalivation.…”

“…The incidence of TB has systematically been decreasing since the last decades of the 20 th century, and there has been a 41% decline in mortality since 1990 [ 14 ]. However, an increase in TB morbidity has been recently observed [ 15 ]. In Poland, TB incidence was 22.2 cases per 100,000 population (8478 cases) in 2011 which is a slight increase comparing to previous years [ 16 ].…”

“…Pulmonary TB is most commonly observed but all parts of the body, including the oral cavity, can be affected [ 2 , 6 , 10 , 13 ]. Extrapulmonary lesions are reported to account for 5% to 50% of all TB cases [ 9 , 15 , 17 , 21 ]. In Poland, extrapulmonary TB was found in 6.9% of all registered cases in 2010 [ 21 ], while in Western Europe and the USA it was found in 18–20% [ 17 ].…”

Primary Lingual Tuberculosis Presenting as Hemimacroglossia: A Case Report

“…Aird has described five pathological types of lesion due to tuberculosis. 8 1) Tubercular ulcer: It is painful and usually develops as a small tubercle which later on softens to form an ulcer. Typically the ulcer is shallow, ovoid, with undermined margins and lined with pale granulation tissue.…”