Rare case of tubercular parotid abscess.

Acute parotitis progressing to parotid abscess is rare in children. Staphylococcus aureus is the usual pathogen in parotid abscess. Granulomatous parotid abscess due to tubercular aetiology is extremely rare. Authors report a case of chronic parotid abscess in a child who received multiple courses of antibiotics without any cure. The ultrasonography and CT scan of the parotid gland confirmed the extent of parotid abscess and the changes in the parotid lymph nodes. The surgical drainage and the biopsy of the lymph nodes lead to the diagnosis of granulomatous abscess. The antitubercular therapy finally cured the disease without further recurrence.

Oral Granulomatous Disease.

Granulomatous diseases are chronic inflammatory disorders whose pathogenesis is triggered by an array of infectious and noninfectious agents, and may be localized or a manifestation of systemic, disseminated disease. As in the skin, oral manifestations of granulomatous inflammation are often nonspecific in their clinical appearance. Thus, in the absence of overt foreign material or a recognizable infectious agent, identifying the underlying cause of the inflammation can be challenging. This article highlights various conditions known to induce granulomatous inflammation within the oral soft tissues.

Extrapulmonary tuberculosis: atypical presentation in otorhinolaryngology.

Tuberculosis (TB) continues to be a major health burden globally more so in low/middle-income countries like India. There is an increase in the prevalence of extrapulmonary TB (EPTB) because of HIV epidemics and increased usage of immunomodulating drugs. EPTB constitutes 15%-20% of all patients with TB and >50% of HIV-TB coinfected patients. We present three such atypical presentations of EPTB in head and neck region. EPTB can mimic any disease, hence knowledge of the unusual presentations helps in making early diagnosis and thereby reduces the morbidity and mortality involved with the disease.

[Tuberculous cheilitis revealing pulmonary tuberculosis]. / Chéilite tuberculeuse révélant une tuberculose pulmonaire.

Tuberculosis of the oral cavity is rare. It is associated with clinical polymorphism and poses above all a diagnostic problem. We report the case of a 42-year-old male patient with tubercular cheilitis. This study aims to focus attention on tuberculosis that can be detected exceptionally in specific locations, such as the oral lip.

Primary oral tuberculosis in a patient with lepromatous leprosy: Diagnostic dilemma.

Pulmonary tuberculosis (TB) is the most common form of TB. Primary infection can also affect the pharynx, cervical lymph node, intestine, or oral mucosa. Historically, the observed incidence of concomitant infection with leprosy and TB is high. However, reports of concomitant infection in modern literature remain scarce. Most cases reported in the literature had borderline/lepromatous leprosy and pulmonary tuberculosis. Extrapulmonary tuberculosis is reported in only 3.2% of leprosy cases. To the best of our knowledge, this is the first case report of primary oral tuberculosis of the tongue in a patient with lepromatous leprosy with Type 2 lepra reaction. The patient was referred to Directly Observed Treatment, Short-Course clinic and started on Category I treatment. She received oral prednisolone for lepra reaction, which was subsequently tapered and stopped, however, she continued to receive other antileprotic drugs (thalidomide and clofazimine). The patient's general condition improved and she is on regular follow up.

Tuberculosis: oral alveolus and pulmonary alveoli coexisting.

Tuberculosis of the oral cavity is uncommon in this antibiotic era. We report a case of a long standing non-healing ulcer of the right upper maxillogingival sulcus, found to be tuberculosis of a rather unusual site in the oral cavity, the alveolus.

Disguised ulcer of lip and buccal mucosa – rare clinicalmanifestation as tuberculosis: a case report / Úlcera de mucosa labial e bucal – uma rara manifestação clínica detuberculose: relato de caso clínico

Introduction: Oral tuberculosis is a chronic granulomatous disease caused by Mycobacterium tuberculosis. According to the World Health Organization (WHO), nearly 2 billion people are infected with tuberculosis. Objective: To report a rare case of oral tuberculosis with ulcers at two different sites. Materials and methods: In order to emphasize the need to consider tuberculosis in the differential diagnosis of non-healing ulcers of oral cavity and the role of oral physician in preventing the spread of such lesions, this article presents a case of oral ulcers at two different sites, diagnosed as tuberculosis ulcer. Results: Oral cavity, which is considered to be a mirror of systemic health, rarely manifests tuberculosis. With increasing number of tuberculosis cases and unusual form of the disease in the oral cavity, the cases are likely to be misdiagnosed. Conclusion: An oral clinician should have a thorough knowledge of tuberculosis and its oral manifestations.

Introdução: A tuberculose oral é uma doença granulomatosa crônica causada pelo Mycobacterium tuberculosis. Segundo a Organização Mundial da Saúde (OMS), cerca de 2 bilhões de pessoas estão infectadas com tuberculose. Objetivo: Relatar um caso raro de tuberculose oral com úlceras em dois locais diferentes. Materiais e métodos: Para realçar a necessidade de considerar a tuberculose sob o diagnóstico diferencial das úlceras não curadas da cavidade oral e o papel do dentista na prevenção da propagação de tais lesões, este artigo apresenta um caso de úlceras orais em dois locais diferentes, diagnosticados como úlcera de tuberculose. Resultados: A cavidade oral, considerada como um espelho da saúde sistêmica, raramente manifesta a tuberculose. Com um número cada vez maior de casos de tuberculose e a forma não usual da doença na cavidade oral, os casos são frequentemente diagnosticados erroneamente. Conclusão: O dentista clínico geral deve ter um conhecimento profundo da tuberculose e de suas manifestações orais.

Parotid tuberculosis associated with cutaneous tuberculosis on a medial epicanthus.

An 83-year-old woman presented with a 2-month history of a gradually enlarging, reddish, crusted papule on her left medial epicanthus. Her medical history did not reveal any systemic disease. She gave no personal history of tuberculosis or any systemic symptoms, such as night sweat, weight loss, and pulmonary abnormalities. Her husband had been treated for pulmonary tuberculosis 30 years ago. A dermatologic examination revealed a 2.5 x 1.2-cm nontender, erythematous plaque with fine, white adherent scales on the left medial epicanthus (figure 1A). All laboratory values were within the normal range. Results from a tuberculin skin test were initially negative. A skin biopsy was performed, and a pathological examination demonstrated multiple noncaseating granulomas with various diameters in the reticular dermis and an infiltrate of neutrophils and lymphocytes in the surrounding dermis (figure 2). Periodic acid-Schiff, Ziehl-Nilsen, gram, and giemsa stains were negative for any microorganism. Leishman-Donovan-like bodies were observed within the epitheloid histiocytes that formed the granulomas. The pathological diagnosis was granulomatous dermatitis. The patient was diagnosed with cutaneous leishmaniasis (CL) based on her clinical appearance and histopathological findings, although the parasite was not detected in the tissue specimens. Treatment with intralesional glucantime for 5 consecutive weeks did not improve her condition. By the end of the fifth week, the patient developed asymptomatic facial swelling and a 1.5 x 1.2-cm erythematous plaque in the left parotid area (figure 1B). An ultrasonographic examination demonstrated a 13 x 11 x 17-mm hypoechoic mass, which suggested pleomorphic adenoma. In addition, lymph nodes, the largest of which were 9 x 10 mm, were noted in the left cervical area. A skin biopsy from the erythematous plaque of the left parotid area demonstrated diffuse neutrophilic infiltration with formation of focal granulomas. Tuberculosis was suspected, and mycobacterium tuberculosis (MT) was isolated from the culture. A tuberculin skin test was performed again, which was positive (12 mm). The erythrocyte sedimentation rate was 35 mm/h, and all other laboratory tests were within normal limits. Pulmonary radiography and thoracic computerized tomography findings were normal. Fine needle aspiration biopsy and ultrasonographic examination of the parotid mass were performed, which revealed necrotic material with neutrophils and lymphocytes (figure 3). We treated the patient with a standard antituberculous regimen, comprising isoniazid 300 mg/d, rifampin 600 mg/d, ethambutol 1200 mg/d, and pyrazinamide 1500 mg/d. By the end of the second month of treatment, the patient improved considerably. There was a marked reduction in facial swelling, and the lesion on the left medial epicanthus regressed dramatically (Figure 4A and Figure 4B). No adverse effects of the medication occurred. An additional 7 months of therapy with isoniazid and rifampin was planned.

Primary tuberculosis: an unusual finding in the oral cavity.

The unusual involvement of the oral cavity in tuberculosis and the non-specific nature of its presentations mean that diagnosis of tuberculosis is often delayed and is an unexpected finding. The aim of this paper is to present a case of primary tuberculosis and discuss the implications of the manifestations and diagnosis of oral tuberculosis. This paper presents an unusual case of a painless, papillary, erythematous lesion in the anterior region of a maxillary edentulous ridge. When the patient concerned was first seen by the author, the lesion had been present for six months. There was cervical lymphadenopathy and it was diagnosed initially as a malignant lesion. Eventually, after biopsy and ultrasound examination, the diagnosis of primary oral tuberculosis was reached. The patient was managed solely by anti-tubercular drug therapy.

Tuberculosis, the culprit behind nonhealing oral lesions: report of two cases.

Nonhealing painless lesions of long duration that did not respond to conventional therapy are the diagnostic challenge to clinician. Two such atypical cases of nonhealing oral lesions manifesting as gingival swelling and odontogenic cyst diagnosed histopathologically as primary oral tuberculosis are presented here. The purpose of this presentation is to point out that, in the absence of any apparent systemic infection the oral tuberculous lesions in the mouth may be discovered before the diagnosis of systemic tuberculosis and the histopathological finding of a persistent nonhealing oral lesion is an important aid in arriving at a diagnosis of this underlying condition.

Coinfections associated with human immunodeficiency virus infection: workshop 1A.

The importance of opportunistic pathogens in HIV disease has been demonstrated from the onset of the epidemic. This workshop aimed to review the evidence for the role of oral microorganisms in HIV-related periodontal disease and HIV transmission and the effect of HIV therapy on periodontal disease. Despite being a common copathogen, tuberculosis seems to have limited oral presentation. The oral manifestations seem to have little impact on the individual and, once diagnosed, are responsive to chemotherapy. The participants debated the available evidence on the role of microorganisms and whether further research was warranted and justified. Although the effects of lipodystrophy on facial aesthetics may be profound and may markedly affect quality of life, there is no evidence to suggest a direct effect on the oral cavity. Though of interest to oral health care workers, lipodystrophy and associated metabolic syndromes were thought to be further investigated by other, more appropriate groups.

Warthin's tumour with coexistent tuberculosis.

A 81-year-old man presented with a 2-month history of swelling of the right angle of the jaw. On histopathological examination a diagnosis of Warthin's tumour with coexistent tuberculosis of the parotid gland was made. PCR for tuberculosis was positive. Tuberculosis of the parotid gland is very rare and coexistence with Warthin's tumour is extremely rare. This case is being reported for its rarity.

A case of immunoglobulin G4-related chronic sclerosing sialadenitis and dacryoadenitis associated with tuberculosis.

We describe a 64-year-old woman with chronic sclerosing sialadenitis and dacryoadenitis, which developed during treatment for cervical lymph node tuberculosis. Anti-tuberculosis treatment did not improve the swelling in the lacrimal and submandibular glands, and a biopsy specimen of the lacrimal gland showed inflammation, with abundant lymphoid follicles with fibrosis and granuloma without caseous necrosis. Immunohistological examination of a repeat biopsy specimen showed abundant immunoglobulin (Ig) G4-positive plasma cell infiltration. Corticosteroid therapy improved the salivary gland swelling without reactivation of the tuberculosis. This case suggests that an abnormal immunological reaction to tuberculosis may be one of the etiological candidates for IgG4-related disease.

Primary tuberculosis of tonsil and posterior oropharyngeal wall.

Pharyngeal tuberculosis is rare and usually occurs in association with primary pulmonary disease. Primary tuberculosis involving the palatine tonsils and the posterior oropharyngeal wall is still a rare clinical entity. We report one such case of primary tuberculosis involving both the palatine tonsils and the posterior oropharyngeal wall in a 22 year-old male. The patient responded to anti-tubercular treatment with complete disappearance of lesion and no sign of recurrence on one year follow-up. The final diagnosis was based upon histopathological report.

Tuberculosis of oral cavity.

Tuberculous involvement of oral cavity is very rare. A 34-year-old male presented with non-healing ulcer at upper lip mucosa. Biopsy from ulcer revealed tuberculous lesion. He also had asymptomatic pulmonary tuberculosis diagnosed during work up for primary site of the disease.

What happens when oral tuberculosis is not treated?

Pulmonary tuberculosis (TB) is the most important form of the disease, although infection may also occur by way of the intestinal tract, tonsils and skin. Oral lesions consist of persistent ulcers or granulomatous masses. A 50 year old man had been diagnosed "necrotising granulomatous inflammation" following a biopsy of a lesion on lower lip, 21 months before at a medical centre. A chest-X-ray had not been performed and he had not been given any advise in respect of treatment. He was admitted to the hospital with cough, sputum, weakness, weight loss and lesions on his lower lip. In radiology, it was detected that he had supraclavicular, submental, cervical, mediastinal lymphadenopathies, pulmonary infiltrations with cavities, thickening and roughness on left oropharengial tonsil, thickenning on inner parts of larynx and bilateral surrenal thickening. The biopsy of lesions on larynx, tonsil and epiglottis revealed "necrotising granulomatous inflammation" and histopathology supported TB infection. Sputum acid-fast bacilli was positive and culture was positive for Mycobacterium tuberculosis complex. Two months of combination treatment resulted in a gradual relief of the symptoms, radiological response, disappearing of neck swelling and healing of lesions on lip, tonsil and larynx. Although unusual oral cavity manifestations of TB are rare, clinicians should be aware of possible occurrance.