The Indian Journal of Tuberculosis - LRS Institute of Tuberculosis ...

Case Report Ind. L Tub., 1992, 39, 45
TUBERCULOSIS OF THE TONGUE A CASE REPORT
A. Chakravarti 1 , VJN. Chaturvedi 2 , N. Samal 3 and P. Narang 4
(Received on 30.11.1990; Accepted on 16.5.1991)
Introduction
By 1937, three hundred fifty seven cases of
lingual tuberculosis had been reported 1
Following the introduction of Streptomycin and
other potent antituberculosis drugs, the
proportion of oral lesions is reported to have
been reduced to just 1% in patients with
pulmonary tuberculosis 2 In a review of 834
patients with tuberculosis, 16 were found to have
upper respiratory tract tuberculosis but only two
had involvement of the tongue 3 and only a few
cases of ulcerative lesion of the tongue as
presenting feature of pulmonary tuberculosis
have been reported 4,5 in recent years. The rare
occurrence of tuberculous ulcerative lesion of the
tongue, as a presenting feature of pulmonary
tuberculosis has induced us to report this case.
Case Report
A 51 year old male presented at the ENT
services of the Mahatma Gandhi Institute of
Medical Sciences, Sevagram, on 1st February,
1990 with multiple painful ulcers over the ventral
surface of the tongue, lip, buccal mucosa. of three
months' duration. He had been treated by a
private practitioner but the lesions had continued
to progress and, therefore, he was referred to the
hospital. Examination of the tongue revealed 2
ulcers measuring 1.5 to 2 cm each with an
intervening normal area (Fig. 1). Buccal mucosa
on the left inner aspect of lower lip also revealed
similar ulcers (Fig. 2). The ulcers were irregular,
superficial, indurated, covered with dirty yellow
slough and painful on palpation. The regional
lymph nodes, specifically submandibular, were
not palpable. Routine laboratory investigations,
were normal except ESR which was 100 mm 1st
hour (Westergren). VDRL was non-reactive.
Smear from ulcerative lesion revealed acid fast
bacilli (AFB++). Sputum examination also
revealed acid fast bacilli. Biopsy taken from the
tongue ulcer under local anaesthesia showed
granulomatous process with tuberculoid reaction,
Langhan's giant cells and epitheloid cells. There
was no evidence of malignancy (Fig. 3).
Skiagram of the chest revealed reticulonodular
infiltration in both upper and mid zone of
left lung suggestive of pulmonary tuberculosis.
The patient was put on antituberculosis
treatment, and the lesions regressed within 5
months.
Discussion
The upper respiratory tract is generally
considered resistant to tuberculosis 6 Moreover,
unusual forms like tongue tuberculosis are likely
to be missed. The points which suggest
tuberculous involvement of the tongue are
superficial nature of the ulcers, presence of
multiple foci and dirty yellow slough 7 - These
ulcers are to be differentiated from chronic
infective granulomatous lesions such as syphilis,
and lupus. Syphilitic ulcers are deep and punched
out. Lupoid lesions have superficial ulceration
associated with healing and cicatrization.
Histopathological study is necessary to confirm
the diagnosis of tuberculosis and also to exclude
carcinomatous changes.
1. Registrar; 2. Professor and Head, Department of Dtolaryngology; 3. Professor and Head, Department of
Pathology; 4. Professor and Head, Department of Microbiology, Mahatma Gandhi Institute of Medical
Sciences, Sevagram, Wardha-442 102.
Correspondence: Dr. V. N. Chaturvedi, Prof. & Head, Deptt. of Otolaryngology, M. G. Institute of Medical
Sciences, P.O. Sevagram-442 102.