Abstract
Oral tuberculous lesions are uncommon and usually develop secondarily to pulmonary tuberculosis. It is often difficult to differenciate them from other conditions such as carcinomas, because of the low incidence. We experienced a case of tuberculosis of the tongue, and the recent cases in Japanese reports were reviewed.
An 81-year-old male with pain on the left border of the tongue came to our clinic on Oct. 3, 1989. Examination revealed an ulcer which measured 56×27mm on the left side of the tongue. The surface of the lesion had a granular appearance with a yellowish white coating, and an induration was palpated on the surrounding tissue adjacent to the posterior part of the ulcer.
A specific inflammation or malignancy of the tongue was determined by clinical diagnosis, and a biopsy was performed. A histological specimen showed granulomatous inflammation with epithelioid cells and Langhans'giant cells. Ziehl-Neelsen stain revealed acid-fast bacilli. A chest X-ray disclosed bilateral diffuse infiltrates with multiple nodular shadows. Sputum was positive for acid-fast bacilli on smear (Grade VIII by Gaffky scale) and culture, with a positive niacin test. The culture of scrapings from the ulcer was also positive.
The lesion was finally diagnosed as tuberculosis of the tongue, and the patient was transferred to the pulmonary disease center for treatment. Chemotherapy with INH, RFP and EB was initiated on Oct. 23, 1989. The ulcer regressed markedly, then resulted in complete healing in seven weeks after the start of antituberculosis therapy.
