Primary tuberculosis clinically presenting as gingival enlargement: a case report

Tuberculosis is a chronic systemic granulomatous disease which rarely affects the oral cavity. Oral lesions can be either primary or secondary to systemic tuberculosis, the former being rare. This is a never-before reported case of primary tuberculosis presenting as a localized diffuse gingival enlargement in an 11-year-old Indian female patient. The diagnosis was reached through identification of positive histopathological features, Tuberculin test results, presence of anti-tubercular antibodies confirmed by a polymerase chain reaction. In view of the recent increase in the incidence of tuberculosis and the prevalence of the same, it is reasonable to include tuberculosis in the differential diagnosis of gingival enlargements. This is essential to avoid any serious complications for both the clinician and patient due to a delay in the diagnosis of such a rare but plausible oral condition.     

Oral tuberculosis : a case report

Tuberculosis can affect any part of the body and oral cavity remains no exception. The oral lesions of tuberculosis, though not common, are seen in various forms. The purpose of this article is to emphasize the importance of early diagnosis of primary tuberculosis of the mouth, which may be misdiagnosed when the oral lesions are the sole manifestation of the disease.     

Primary tuberculosis of the oral cavity

Tuberculosis is one of the major causes of ill health and death worldwide. Nevertheless, tuberculous lesions of the oral cavity are rare and can be a diagnostic challenge, particularly in young immunocompetent patients. Most of the cases are secondary to pulmonary disease and the primary form is uncommon. In this paper, we present a case of primary oral tuberculosis, affecting the floor of mouth in a 13-year-old Brazilian male patient.     

Importance of rapid management in painful progressive ulcerative lesions in elderly immunosuppressed patients: Two case reports

Oral manifestations of tuberculosis (TB) are not so frequent, and the lesions may emerge in immunosuppressed patients as a secondary expression of pulmonary TB. The following two case reports focus on the clinical challenge of early diagnosis of painful ulcerative lesions in oral mucosa that occurred in two senior females, both human immunodeficiency virus negative patients, however receiving immunosuppressing medication. The patients did not present classic symptoms of TB. Nevertheless, based on different studies, extrapulmonary TB should still be considered as differential diagnosis for the oral mucosa lesions developed by these patients.     

Oral tuberculosis: a clinical evaluation of 42 cases

OBJECTIVES: A retrospective review of a large series of oro-facial cases of tuberculosis to analyse clinical, histopathological, and radiological aspects, as well as those of chemotherapy. MATERIALS AND METHODS: A total of 42 cases of tuberculosis of the oro-facial region were examined. Thirteen patients had a primary form and 29 a secondary form of the disease. Diagnosis was based on careful clinical examination, Mantoux reaction, histopathological examination, microbiological cultures and immunological investigation with the detection of antibodies against Mycobacteria in the patients' serum (ELISA). RESULTS: Cases examined consisted of 27 males and 15 females. The age range was 3 to 73 years (mean age 31 years). Clinical manifestations comprised oral ulcers in 69.1%, bone involvement in 21.4%, and salivary gland and/or lymph node involvement in 14.3%. A total of 79.4% patients with secondary disease had pulmonary lesions, 15 of whom showed clinical and radiological signs of activity; there was one case of bilateral renal lesions and two of skin lesions. CONCLUSIONS: Oro-facial tuberculosis is often difficult to diagnose and it should be an important consideration in the differential diagnosis of lesions that appear in the oral cavity. The most important diagnostic tools remain a careful clinical evaluation, biopsy for histologic study, as well as acid-fast stains, culture, and immunological assays, and skin testing.     

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.     

Primary tuberculosis of the tongue: a case report

AIM: The purpose of this article is to report a rare case of primary tuberculosis of the tongue. BACKGROUND: Tuberculosis is an infectious, chronic granulomatous disease that can involve almost any organ in the body, but primary lesions are usually confined to the lungs. Oral lesions are an infrequent occurrence in tuberculosis, and tuberculosis of the oral cavity is often a consequence of active pulmonary tuberculosis. Although primary tuberculosis in the oral cavity has been documented, it is a rare occurrence. REPORT: A 42-year-old male patient presented with chief complaints of severe pain and ulceration on the ventrolateral surface of the left side of the tongue, measuring about 1.25 x 1.50 cm with surrounding erythema and induration of one-month duration. The ulcer was initially painless but became painful later with increased severity over time. The sore tongue caused difficulty in eating, drinking, swallowing, and even talking. The patient also complained of malaise for some duration, but there was no history of fever, cough, weight loss, and his bladder-bowel habits were normal. An excisional biopsy differentiated the lesion from squamous cell carcinoma and confirmed the diagnosis. SUMMARY: Even though primary tuberculosis in the oral cavity is a rare finding, it must be included in the differential diagnosis of mucosal lesions. This case provides a clinical example of the importance of this inclusion for the well being of the patient and for the community due to the communicable nature of the disease.     

Tuberculosis of the tongue. A case report with immunologic study.

A case of tuberculosis of the tongue in a 59-year-old woman with active pulmonary tuberculosis is described. The lingual tuberculosis was considered to be a secondary infection from the pulmonary disease, but the oral lesions were, in fact, noticed prior to recognition of the pulmonary lesion. This case was marked by a multiplicity or oral lesions arising on the bilateral surfaces of the tongue. Immunologic investigation revealed that cell-mediated immune responses in the patient were within the normal range in terms of the PPD skin test, DNCB skin test, lymphocyte transformation test, and subpopulation of the peripheral blood lymphocytes. Rosette-forming assay on the frozen sections disclosed that T-lymphocytes and macrophages were predominant in the lymphoid cells infiltrating the tuberculous lesion.     

Primary gingival tuberculosis: A rare clinical entity

Tuberculosis is a specific granulomatous infectious disease and a major cause of death in developing countries. Primary gingival tuberculosis is extremely rare and forgotten entity. Oral lesions usually appear as secondary to primary tuberculosis infection elsewhere. The lesion may take the form of nodules, ulcers, or elevated fissures. We report a case of primary tuberculosis of gingiva, manifesting as gingival enlargement with ulceration and discharge. Diagnosis was based on histopathologic examination, complete blood count, chest X-ray, and immunologic investigations with detection of antibodies against Mycobacterium tuberculosis. With the recent increase in the incidence of tuberculosis, this case report also emphasizes the need for clinicians to be aware of this possibility, consider tuberculosis in the differential diagnosis of gingival enlargement, and thus, play a role in the early detection of this disease.     

Primary oral tuberculosis: a report of a case diagnosed by polymerase chain reaction

We present a case of primary oral tuberculosis, affecting the maxillary gingiva and causing alveolar bone loss in a 34-year-old Colombian female patient. Definitive diagnosis was facilitated by polymerase chain reaction analysis, a useful modern tool for the diagnosis of infectious diseases. The location and clinical presentation of this lesion is unusual and underlines the importance of considering tuberculosis in the differential diagnosis of oral lesions that affect the gingiva and alveolar bone.     

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.     

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.     

Primary tuberculous gingival enlargement: a rare entity

With the advent of effective drug therapy, tuberculous lesions of the oral cavity have become so rare that they are frequently forgotten. Primary gingival tuberculosis is extremely rare and usually manifests as ulcer. We report the first case of primary tuberculosis manifesting as gingival enlargement, which was the only presenting sign of tuberculosis. Diagnosis was based on histopathology (hematoxin and eosin staining), complete blood count, polymerase chain reaction assay and immunologic investigation with the detection of antibodies against Mycobacterium tuberculosis. The possibility of gingival enlargement due to drugs, leukemia, fungus and sarcoidosis was ruled out. Antituberculous therapy over 6 months 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 emphasizes the need for dentists to include tuberculosis in the differential diagnosis of gingival enlargement so that they may play a role in its early detection.     

The histopathology of syphilis of the oral mucosa

BACKGROUND: Reported cases of syphilis in the United States, Europe and elsewhere are increasing in number. Clinical manifestations are protean, and oral biopsies may be taken where the diagnosis is unsuspected, but data on the histopathology of oral mucosal syphilis are sparse. METHODS: The histopathology of five oral lesions in patients with serologically proven syphilis was reviewed. RESULTS: There were two cases of primary syphilis, one secondary and two tertiary. Epithelial hyperplasia was present in three cases, and was pseudocarcinomatous in one case of primary syphilis, and psoriasiform in the secondary lesion, where heaped-up epithelium surrounded a defined crater covered by flatter epithelium. Plasma cell (primary and secondary disease) and granulomatous (tertiary) infiltrates were prominent. Other features observed were endarteritis (5/5), plasma cell neuritis (3/5) and spirochetes (4/5). CONCLUSIONS: Although no single microscopic feature is specific, a diagnosis of syphilis should be considered where there is unusual epithelial hyperplasia, granulomatous or plasma cell-predominant chronic inflammation, endarteritis and neuritis.     

Dental health in professional musicians. A radiographic study in dental conscious subjects

A study has been performed covering the oral health of 247 professional musicians in Stockholm aged 21-60 yr. In an earlier study the oral hygiene was found to be of a high standard. The following part of this study concerned dental health i.e. remaining and intact teeth, decayed and filled proximal surfaces. All registrations were made on intraoral full mouth surveys. The number of remaining teeth was large, but decreased with age. In the 51-60 age group, 24.1 teeth remained on average. The number of teeth intact ranged from 55-28% of remaining teeth in the youngest and oldest age group respectively. A total of 555 caries lesions were registered on proximal surfaces, 49.1% being primary lesions in the enamel, 21.4% primary lesions into the dentin and 29.5% secondary lesions. Only 3.3% of all filled surfaces showed secondary lesions. The number of secondary lesions increased with age. A total of 30.9% of the subjects showed no proximal lesions. It was concluded that in adults who have adopted proper oral hygiene it is possible to preserve a large number of teeth and to limit the deterioration caused by caries.     

Prevention of oral cancer

Etiology control is the most important primary prevention of oral cancer. The use of tobacco and alcohol increases the risk of a squamous cell carcinoma of the oral mucosa. The dentist can play an important role in the secondary prevention or screening for premalignant lesions, asymptomatic malignancies and second primary tumours of the oral cavity. Because of their age, edentulous patients run a high risk of oral cancer. Therefore, a regular oral check-up of these patients should be recommended.     

HIV/TB co-infection: literature review and report of multiple tuberculosis oral ulcers.

Human immunodeficiency virus/tuberculosis (HIV/TB) co-infected subjects demonstrate enhanced HIV replication and plasma viremia; CD4+ T-cell depletion; morbidity and mortality; and susceptibility to secondary bacterial and fungal infections compared to subjects solely infected with HIV. As the incidence of HIV/TB infection has been increasing, one would have expected to encounter oral lesions of tuberculosis more frequently. However, such oral lesions are uncommon. The lesions usually occur as ulcerations of the tongue. We report an additional case in an HIV/TB co-infected 39 year-old black male, who presented with chronic, painless, multiple oral ulcers, occurring simultaneously on the tongue, bilaterally on the palate and mucosa of the alveolar ridge. Microscopic examination confirmed the presence of chronic necrotizing granulomatous inflammation, with the identification of acid fast bacilli in the affected oral mucosal tissue. Anti-retroviral and anti-tuberculous treatment resulted in the resolution of the oral lesions. Confirmatory histopathological diagnosis following a biopsy is essential to determine the exact nature of chronic oral ulceration in an HIV individual and especially to distinguish between oral squamous cell carcimoma, lymphoma, infection (bacterial or fungal) and non-specific or aphthous type ulceration.     

Tuberculosis of the oral cavity: a systematic review

Kakisi OK, Kechagia AS, Kakisis IK, Rafailidis PI, Falagas ME. Tuberculosis of the oral cavity: a systematic review. Eur J Oral Sci 2010; 118: 103–109. © 2010 The Authors. Journal compilation © 2010 Eur J Oral Sci The recent increase in the incidence of tuberculosis, combined with an emerging global resistance to antituberculous drugs, warrants an increased awareness of the involvement of Mycobacterium tuberculosis in persistent or atypical lesions in the oral cavity. We sought to review the published reports of mycobacterial infection of the oral cavity found in the literature in otherwise uncompromised patients, from 1950 to the present day, and analyzed the documented manifestations. M. tuberculosis infects all parts of the mouth (soft and hard palate, uvula, buccal mucosa, gingivae, lips, tongue, maxilla, and mandible) more often in men than in women, appearing predominantly in the form of ulcerative lesions. It was found as a secondary infection in 58% (54% pulmonary, 4% extrapulmonary) of patients and as a primary infection in 42% of patients. Carcinomas are found to co‐exist in the same lesion site in 3% of patients. In approximately 50% of patients, an oral manifestation of TB has led to the diagnosis of a previously unknown systemic infection, which resulted in a timely and effective treatment. The investigation for tuberculosis should therefore be actively pursued in the dental surgery. Diagnostic work‐up for systemic involvement and control of healthcare‐associated spread is important, while therapeutic options are still considered adequate.     

Oral tuberculosis

A case with oral tuberculosis and unaware of systemic tuberculosis is reported. The oral lesions clinically manifested as two painless ulcerations in the hard palate. Pulmonary tuberculosis was diagnosed following the histopa-thologic and bacteriologic examination of the oral lesions.     

Oral candidiasis in Sj?gren's syndrome: prevalence, clinical correlations, and treatment

Red, nonulcerated, uncomfortable oral mucosal lesions that are often thought to be caused by chronic xerostomia develop in some patients with Sj?gren's syndrome (SS). However, we find that these lesions (1) clinically resemble chronic atrophic candidiasis (CAC), (2) usually yield Candida species from their surface, and (3) can be eliminated by topical antifungal drugs in spite of continuing xerostomia. In 246 patients who had primary or secondary SS, we correlated the presence or absence of atrophic oral mucosal lesions with the patient's salivary function and other clinical features. The 91 patients (37%) who had these lesions were older, had a greater frequency of primary SS and of oral symptoms, had had oral symptoms for a longer period, had more salivary gland inflammation, and had lower stimulated parotid flow rates than the 155 patients without CAC (p less than 0.05). However, unstimulated whole salivary flow rates and denture status were not significantly different. Topical antifungal treatment, begun on 47 patients, eliminated lesions in some. The methods of treating CAC are discussed. Candida-associated oral mucosal lesions do not develop in all patients with SS, but in susceptible patients, SS leads to a reversible form of CAC that is not associated with dentures.