LGCmain
Indian Journal of Pathology and Microbiology
Home About us Instructions Submission Subscribe Advertise Contact e-Alerts Ahead Of Print Login 
Users Online: 151
Print this page  Email this page Bookmark this page Small font sizeDefault font sizeIncrease font size
IJPM is coming out with a Special issue on "Genitourinary & Gynecological pathology including Breast". Please submit your articles for these issues


 
LETTER TO EDITOR Table of Contents   
Year : 2009  |  Volume : 52  |  Issue : 3  |  Page : 442-443
Gingival tuberculosis


1 Department of Pathology, Government Dental College, Patiala, India
2 Department of Periodontia, Government Dental College, Patiala, India

Click here for correspondence address and email

Date of Web Publication12-Aug-2009
 

How to cite this article:
Bal MS, Bharti V, Singh A. Gingival tuberculosis. Indian J Pathol Microbiol 2009;52:442-3

How to cite this URL:
Bal MS, Bharti V, Singh A. Gingival tuberculosis. Indian J Pathol Microbiol [serial online] 2009 [cited 2019 Dec 14];52:442-3. Available from: http://www.ijpmonline.org/text.asp?2009/52/3/442/55023


Sir,

Oral tuberculosis, especially of gingiva, is uncommon. Only a few cases have been reported in the world literature.

A 40-year-old female presented with enlargement of gingiva in left upper anterior region. It was reddish, ulcerative and bleeding [Figure 1]. Earlier the patient was treated for inflammatory disorders but to no avail. An incisional biopsy from the swollen reddish part grossly was in the form of multiple grayish white and pinkish soft tissue pieces, collectively measuring 0.8 x 1 cm.

Microscopic examination showed epithelioid cell granulomas with caseous necrosis surrounded by lymphocytes, epithelioid cells and Langhans type of giant cells [Figure 2]. The diagnosis of necrotizing epithelioid granulomatous lesion with possibilities of tuberculosis and fungal infections was given. Mantoux test was positive (10.2mm induration in 24 h). ZN staining of the tissue sections and sputum examination were negative for AFB. X-ray chest was normal. The underlying bone was not involved.

Total and differential lukocyte counts (TLC and DLC) were within normal limits. The erythrocyte sedimentation rate (ESR) was elevated (48 mm in first hour WG). With the background of these findings, ELISA for detecting IgM, IgG, anti-mycobacterium tuberculosis antibodies was positive suggesting tuberculosis infection.

Later, it was confirmed by polymerase chain reaction (PCR) on scrapings. Patient was put on anti-tubercular therapy and she has responded well.

Tuberculosis of the oral cavity is uncommon which must be considered in the differential diagnosis of granulomatous lesions in the Indian subcontinent. The possibility of primary lesions elsewhere in the body should be ruled out before arriving at the diagnosis of primary tuberculosis.

The diagnosis was supported by other relevant investigations and the patient has improved with anti-tubercular therapy.

Gingival enlargements which are not responding to usual anti-inflammatory treatment must be biopsied and if granulomas are seen, possibility of granulomatous lesions including primary oral tuberculosis must be considered, as incidence of tuberculosis is increasing day by day in India.

Tuberculosis of the oral cavity is very rare. At this site, it is usually seen on the tongue as a painful ulcer. [1] It may also occur on the floor of the mouth, lip, cheek, soft palate, anterior tonsillar pillar, uvula, gingiva and alveolar mucosa. [2],[3]

Oral tuberculous lesions are usually secondary to lung involvement [4] and are frequently seen affecting up to 0.5% of elderly tuberculosis patients, however, primary oral tuberculosis affecting gingiva is very rare. [5]

 
   References Top

1.Rosai J. Oral Cavity and Oropharynx. Ackerman's Surgical Pathology. Vol 1. 8 th ed. Singapore: Harcourt Brace and Company Asia PTE Ltd; 1996. p. 226.  Back to cited text no. 1    
2.Rauch DM, Friedman E. Systemic tuberculosis initially seen as an oral ulceration: report of a case. J Oral Surg 1978;36:387-9.  Back to cited text no. 2    
3.Hashimoto Y, Tanioka H. Primary tuberculosis of tongue: r0 eport of a case. J Oral Maxillofac Surg 1989;47:744-6.  Back to cited text no. 3    
4.de Aguiar MC, Arrais MJ, Mato MJ. Tuberculosis of the oral cavity: a0 case report. Quintessence Int 1997;28:745-7.  Back to cited text no. 4    
5.Sharma CG, Pradeep AR, Karthikeyan BV. Primary Tuberculosis clinically presenting as gingival enlargement: A case report. J Contemp Dent Pract 2006;5:108-14.  Back to cited text no. 5    

Top
Correspondence Address:
Manjit Singh Bal
Department of Pathology, Government Dental College, Patiala
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.55023

Rights and Permissions


    Figures

  [Figure 1], [Figure 2]



 

Top
 
  Search
 
  
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


    References
    Article Figures

 Article Access Statistics
    Viewed2050    
    Printed70    
    Emailed1    
    PDF Downloaded271    
    Comments [Add]    

Recommend this journal