as an ulcer, a fissure, a tuberculoma or a diffuse giossitis. Tuberculosis may involve any surface of the tongue, edge or tip being the commonest sites. The case ...
Orbital apex syndrome due to mucormycosis caused
ACKNOWLEDGEMENT
Otolaryngol Head Neck Surg 2003;55:208–10.
We acknowledge the guidance given by Dr. B. M. Hemashettar (Former
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(C. D. C. Atlanta U.S.A) for confirming the identification of the fungus. 7.
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Ophthalmol 1961;65:226–37. Lowe JR, Hudson WR. Rhinocerebral phycomycoses and Internal carotid artery thrombosis. Arch Otolaryngol 1975;101:100–3. Rippon JW. The pathogenic fungi and the pathogenic Actinomycetes Mucormvcosis in medical mycology. W.B Saunders: Philadelphia; 1974. p. 430–47. 5.
Chakrabarti A, Sharma SC, Chander J. Epidemiology and Pathogenosis of Paranasal Sinus mycoses. Otolaryngol Head Neck Surg
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Address for Correspondance Dr. Suman P. Rao T-5, RH-2, Sector 9, CBD Belapur, Navimumbai – 400 614, India.
PRIMARY LINGUAL TUBERCULOSIS PRESENTING AS COLD - ABSCESS TONGUE: A CASE REPORT S. K. Vishwakarma, Shraddha Jain, Manisha Gupta
ABSTRACT: Oral manifestation of tuberculosis is uncommon Tongue is the most common oral site of involvement, where the presentations are varied. Here we report a case of primary lingual tuberculosis with an unusual presentation as a cold abscess. Key Words: Lingual tuberculosis, cold-abscess
INTRODUCTION Oral manifestation of tuberculosis is rare with an incidence of 1.4%. It could be primary tuberculous infection or secondary to pulmonary disease. Soft tissues are more frequently involved than bony structures, with the mandible more frequently involved than the maxilla. Of the oral soft tissues affected, the tongue is the most common site. Morgagni (1761) described first case of lingual tuberculosis. Other sites include the floor of mouth, soft palate, gingiva, lips, and hard palate. Primary tuberculous infection may occur at extrapulmomary sites like gastro-intestinal tract, oropharyngeal lymphoid tissue and skin. These less common portals of entry are associated with primary complexes, similar to those of the pulmonary form, developing at these sites and in the corresponding draining nodes.
Secondary tuberculous infection of the oral cavity arises in a previously sensitized individual and is associated with pulmonary lesions. We report a case of primary lingual tuberculosis with an unusual presentation. CASE REPORT A 13 year old female presented in ENT OPD of GTB Hospital with complaints of Fever for 3 months and a swelling over tongue for 15 days. Fever was continuous, low grade, with evening rise of temperature and associated with complaints of anorexia, malaise and weight loss which did not respond to medical treatment. There was no history of cough or night sweats. On clinical examination, there was a swelling over the tongue
Department of ENT, UCMS and GTB Hospital, Shahdara, Delhi, India Indian Journal of Otolaryngology and Head and Neck Surgery Vol. 58, No. 1, January-March 2006
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Primary lingual tuberculosis presenting as cold
of size 4 cm x 3 cm x 3 cm involving right lateral border of tongue, with well-defined margins, soft and fluctuant in consistency, non-tender and became more prominent on protrusion of tongue [Figure 1]. Transillumination was absent Pus was aspirated from the swelling and sent for microscopy and culture examination. There was also ipsilateral pre-auricular swelling approximately 3 cm x 2 cm in dimensions with associated ipsilateral cervical lymphadenitis involving both Submandibular and Jugulodigastric group of lymph nodes. On abdominal examination, there was splenomegaly. The haematological studies showedd haemoglobin 9.2 gm%, T LC --7, b00/cu. mm, DLC – N52L43E2 M2 B1 and ESR was 120 mm at the end of one hour by Westergren method. LFT and KFT were within normal limits. Chest X-ray was normal. Repeated direct examination of sputum and culture for AFB were negative. Serological studies for HIV Abs and VDRL were non reactive. USG abdomen showed splenomegaly. Widal Test was also positive for which patient was given oral Ciprofloxacin 500 mg twice daily for 15 days, Splenomegaly regressed after the course of ciprofloxacin. FNAC from the base of the swelling over the tongue, preauricular swelling and lymph nodes showed chronic inflammatory cells including lymphocytes and epitheliod cells with areas of caseation necrosis. Microscopy and culture of the pus from the tongue swelling was positive for Acid Fast Bacilli which was consistent with Tuberculosis. The patient was placed on anti-tubercular treatment with 4 drugs including Rifampicin 450 mg, Isoniazid 300 mg, Pyrazinamide 1500 mg and Ethambutol 800mg. The response was dramatic with considerable decrease in the size of the swelling on tongue, and fever after 1 month of anti tubercular treatment. DISCUSSION Tuberculosis of the oral cavity is uncommon and pharyngeal lesions are extremely rare. (Hashimoto and Tanioka). Oral cavity tuberculosis may be either Primary or secondary; in the secondary type, it is also accompanied by pulmonary disease occurring in 0.05-1.5% of such patients (Verma et al). The tongue and palate are the most common sites of involvement for oral lesions. Primary oral tuberculous lesions generally occur in younger patients with associated caseation of the dependent lymph nodes (Hashimoto and Tanioka). The tongue is the most common oral site of involvement (Waldman), where the tuberculous lesion may manifest itself
Figure 1: Clinical photograph showing cold-abscess over tongue.
as an ulcer, a fissure, a tuberculoma or a diffuse giossitis. Tuberculosis may involve any surface of the tongue, edge or tip being the commonest sites. The case we report presented as a cold abscess over the margin of the tongue. There was no associated pulmonary lesion as confirmed by chest x-ray and absence of acid-fast bacilli in the sputum. So this was a case of primary lingual tuberculosis. Oral tuberculous lesions, as described by Lynch), are characterized by severe, unremitting and progressive pain that interferes seriously with proper nutrition. Our patient had a non-painful lesion. This rare condition should be considered in the differential diagnosis of patients with tender or non-tender, non-healing tongue lesions, who are not responding to antibiotic treatment. REFERENCES 1.
Gupta IC, Nagrath C, Salgia KM. Tuberculosis of tongue: A case report.
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Jamal Jawad and FOUAD–EL–ZUEBI. Primary lingual tuberculosis:A Case Report. J Laryngol Otol 1996;110:177–8-.
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Verma A, Mann SB, Radorta B. Primary tuberculosis of the tongue. Ear Nose Throat J 1989;68:719–20.
Address for Correspondance Dr. SK Vishwakarma Department of ENT, UCMS and GTB Hospital, Shahdara, Delhi, India
Indian Journal of Otolaryngology and Head and Neck Surgery Vol. 58, No. 1, January-March 2006
