|Year : 2009 | Volume
| Issue : 3 | Page : 126-128
Tuberculosis of tongue: Report of a rare case
Altaf Hussain Chalkoo, Suhail Hamid Latoo
Department of Oral Medicine and Radiology, Oral Pathology and Microbiology, Govt. Dental College, Srinagar, India
|Date of Web Publication||7-Jan-2010|
Altaf Hussain Chalkoo
Department of Oral Medicine and Radiology, Govt. Dental College, Srinagar
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Tuberculosis is a common infectious disease that is caused by mycobacteria, primarily Mycobacterium tuberculosis. Tuberculosis most commonly affects the lungs. Tongue tuberculosis is very rarely described in the literature. Tongue tuberculosis can be primary with no evidence of involvement of other organs, especially the lungs, or, more commonly, secondary to pulmonary tuberculosis. The occurrence of tuberculosis of tongue as a primary lesion is quite rare and invariably the condition is associated with pulmonary or laryngeal tuberculosis. In this article, a 58-year-old male reported to us with two months history of a painful ulcerated lesion on his tongue and respiratory symptoms. Chest radiograph showed bilateral infiltrates and multiple cavities in the upper and middle lung fields. Tongue biopsy revealed granuloma, which is typical for tuberculosis, and his sputum smear was positive for acid fast bacilli. The patient was started on a regimen of isoniazide, rifampicine, pyrazinamide and ethambutol. The tongue completely healed within a month. In conclusion, tuberculosis should be taken into consideration in differential diagnosis of chronic ulcerative tongue lesions.
Keywords: Tuberculosis, tongue, pulmonary
|How to cite this article:|
Chalkoo AH, Latoo SH. Tuberculosis of tongue: Report of a rare case. J Indian Acad Oral Med Radiol 2009;21:126-8
| Introduction|| |
Tuberculosis is a common infectious disease that generally affects the lungs, but it can also affect the central nervous system, the lymphatic system, the circulatory system, the genitourinary system, bones, joints and even the skin.  Tongue tuberculosis is very rarely described in the literature. It can be primary with no evidence of involvement of other organs, especially the lungs, or, more commonly, secondary to pulmonary tuberculosis. ,,, We present a case of tongue tuberculosis secondary to pulmonary tuberculosis.
| Case Report|| |
A 58-year-old male reported to our hospital with two months history of a painful ulcerated lesion on his tongue. During that period, he also had cough, sputum production and weight loss. He had a history of cigarette smoking of 30 cigarettes per day. On examination, his tongue was edematous and there was an ulcerated lesion on the dorsal surface of tongue [Figure 1]. There was not any pathologic finding on physical examination of other systems.
Chest radiograph showed bilateral infiltrates and multiple cavities in the upper and middle lung fields [Figure 2]. Complete blood cell count, routine biochemical tests and urine analysis were within normal limits. Erythrocyte sedimentation rate was 75 mm in first hour. HIV test was negative.
Tongue biopsy revealed multiple granulomas consisting of aggregates of chronic inflammatory cells in the form of lymphocyes, histiocytes, epitheloid cells and giant cells. Both lagerhan and foreign body giant cell were seen. Some granulomas showed caseous necrosis in the centre. [Figure 3]a-d.
Patient's sputum smear was positive for acid fast bacilli. The tuberculin skin test was also positive.
He was started on a regimen of isoniazide (300 mg/day), rifampicine (600 mg/day), pyrazinamide (1500 mg/day) and ethambutol (1500 mg/day). The tongue completely healed within a month. Two months after therapy, the sputum smear changed to negative.
| Discussion|| |
Tuberculosis (abbreviated as TB for Tubercle Bacillus) is a common infectious disease that is caused by mycobacteria, primarily Mycobacterium tuberculosis. Tuberculosis most commonly affects the lungs (as pulmonary TB), but can also affect the central nervous system, the lymphatic system, the circulatory system, the genitourinary system, bones, joints and even the skin. Other mycobacteria such as Mycobacterium bovis, Mycobacterium africanum, Mycobacterium canetti, and Mycobacterium microti can also cause tuberculosis, but these species do not usually infect healthy adults. 
TB is spread by aerosol droplets expelled by people with the active disease of the lungs when they cough, sneeze, speak, kiss, or spit. These infectious droplets are 0.5 to 5 ΅m in diameter and about 40,000 can be produced by a single sneeze.  The disease can also spread through the sharing of the unsterilized eating utensils of the infected person; in rare cases, it can spread from a pregnant woman with active TB to her fetus. 
Over one-third of the world's population now has the TB bacterium in their bodies and new infections are occurring at a rate of one per second. Not everyone who is infected develops the disease and asymptomatic latent TB infection is the most common. However, one in ten latent infections will progress to active TB disease which, if left untreated, kills more than half of its victims.  In the patients where TB becomes an active disease, 75% of these cases affect the lungs, where the disease is called pulmonary TB. Symptoms include a productive, prolonged cough of more than three weeks duration, chest pain and coughing up blood. Systemic symptoms include fever, chills, night sweats, appetite loss, weight loss and paling, and those afflicted are often easily fatigued. When the infection spreads out of the lungs, extrapulmonary sites include the pleura, central nervous system in meningitis, lymphatic system in scrofula of the neck, genitourinary system in urogenital tuberculosis, and bones and joints in Pott's disease of the spine. An especially serious form is disseminated or miliary tuberculosis. Extrapulmonary forms are more common in immunosuppressed persons and in young children. Infectious pulmonary TB may co- exist with extrapulmonary TB, which is not contagious. 
Tongue is the most common structure of oral cavity affected by tuberculosis.  Tongue tuberculosis can be primary with no evidence of involvement of other organs, especially the lungs, or, more commonly, secondary to pulmonary tuberculosis. ,,, In primary oral tuberculosis, the organisms are directly inoculated on the oral mucous membrane of a person who has not been infected. In the secondary type, oral tuberculosis usually coexists with pulmonary disease. Self inoculation may take place from infected sputum or hematogenous seeding. However, the role of trauma cannot be underestimated, as the stratified squamous epithelium of the oral cavity normally resists direct penetration by tubercle bacilli. ,,,,,
According to the views predominating at the world, both primary and secondary tuberculosis of tongue and oral cavity are rare and occur in less than 0.2% of all cases of tuberculosis.  Tongue tuberculosis is more common among males than females and is usually observed at patients aged over 40 years.  The dorsal surface is more commonly involved in tongue tuberculosis.  A single ulcer is the most frequent lesion of tongue tuberculosis. It may rarely occur as a fissure, tuberculoma, diffuse glossitis or multiple ulcers.  Chronic ulcerating type is always secondary to pulmonary tuberculosis. 
We present a case of tongue tuberculosis secondary to pulmonary tuberculosis in a 58-year-old male. Our patient had a single ulcer on the dorsal surface aspect of tongue and this lesion was secondary to pulmonary tuberculosis.
The differential diagnosis of tongue tuberculous lesions include malignancy, granulomatous disease, syphilis, traumatic and aphtous ulcers, mycotic infections. , Biopsies for histopathological and microbioligical examinations should be obtained for definite diagnosis.  In our case, we performed tongue biopsy and it revealed granuloma typical for tuberculosis.
Patients with tongue tuberculosis respond well to antituberculous therapy because tongue is highly vascular. In most cases, tongue lesions heal completely within few months. ,,,, In the present case, the tongue completely healed within a month and the sputum smear changed to negative two months after therapy.
| Conclusion|| |
Although tuberculosis of tongue is rarely observed, it should be taken into consideration in differential diagnosis of chronic tongue lesions.
| References|| |
|1.||Raviglione MC, O'Brien RJ. Tuberculosis. In: Harrison's Principles of Internal Medicine (Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, et al. eds.), 16 th ed., McGraw-Hill Professional, 2004. p. 953-66. |
|2.||Gupta A, Shinde KJ, Bhardwaj I. Primary lingual tuberculosis: A case report. J Laryngol Otol 1998;112:86-7. |
|3.||Ramesh V. Tuberculoma of the tongue presenting as macroglossia. Cutis 1997;60:201-2. |
|4.||Ucinska R, Sieminska A, Stominski JM. Tuberculosis of the tongue. Case Rep Clin Pract Rev 2002;3:102-4. |
|5.||Aktoπu S, Eriώ FN, Dinη ZA, Tibet G. Tuberculosis of the tongue secondary to pulmonary tuberculosis. Monaldi Arch Chest Dis 2000;4:287-8. |
|6.||Cole EC, Cook CE. "Characterization of infectious aerosols in health care facilities: An aid to effective engineering controls and preventive strategies". Am J Infect Control 1998;26:453-64. |
|7.||World Health Organization (WHO). Tuberculosis Fact sheet N 104 - Global and regional incidence. March 2006, Retrieved on 6 October 2006. |
|8.||Prada JL, Kindelan JM, Villanueva JL, Jurado R, Sαnchez-Guijo P, Torre-Cisneros J. Tuberculosis of the tongue in two immunocompetent patients. Clin Infect Dis 1994;19:200-2. |
|9.||Kφksal D, Acican T, Kanat F, Durmaz G, Ataoglu O, Cobanli B. Tuberculous ulcer of the tongue secondary to pulmonary tuberculosis. Aust N Z J Med 2000;30:518-9. |
|10.||Arinc S, Arinc B, Bayal I, et al. Secondary lingual tuberculosis: A case report. Turkish Respir J 2003;4:25-6. |
|11.||Zivkovic D, Velojic D, Dordevic D. Tuberculosis of the tongue in chronic hematogenous lung tuberculosis. Pneumologie 1993;47:36-7. |
[Figure 1], [Figure 2], [Figure 3]