Oral tuberculosis as primary manifestation: report of four cases

Tuberculosis is a chronic, infectious granulomatous disease caused by a single microbial agent. Despite advances in the diagnosis and management of tuberculosis, it remains a major health problem worldwide. Though it is reported to be highly endemic, oral tuberculous lesions are extremely rare. Four unusual cases were reported to the department of Oral Pathology, Subharati Dental College, Meerut, within a period of one year. First case was of a swelling over left parotid region since one year. Second case was an ulcer on the right buccal mucosa since three months. Third was a swelling between lower premolars since 23 months and fourth case was a swelling in the right lower posterior region since 23 months. Based on the history and clinical examination they were diagnosed provisionally as pleomorphic adenoma, epidermoid cyst, benign lymphoepithelial lesion, squamous cell carcinoma and deep mycotic infection. Histopathological examination, however, showed the granulomatous lesions with caseation necrosis and Langhans giant cell. The patients were put on antituberculous drugs and on review we found excellent recovery of the respective lesions. The purpose of reporting these cases is to emphasize the diverse and variable manifestations of tuberculosis. Although these cases were unusual, they nevertheless indicate that a high index of suspicion regarding Mycobacterium etiology, both tuberculous and non tuberculous should be present in head and neck lesions.