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Year : 2019  |  Volume : 6  |  Issue : 2  |  Page : 117-118

Tuberculosis of tongue, an enigma: Report of two cases

1 Department of Pathology, Calcutta Medical College, Kolkata, India
2 Department of Pathology, Bankura Sammilani Medical College, Bankura, West Bengal, India
3 Department of Pathology, Sagar Dutta Medical College, Kolkata, India

Date of Submission13-Aug-2018
Date of Decision15-Aug-2018
Date of Acceptance30-Sep-2018
Date of Web Publication23-May-2019

Correspondence Address:
Anindya Adhikari
Vill-Basudevpur, P. O. Banipur, P.S. Sankrail, Howrah - 711 304, West Bengal
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/cjhr.cjhr_124_18

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Tuberculous granuloma of the tongue is a rare entity and constitutes a negligible percentage of all inflammatory lesions of that organ. Herein, we report two cases of granulomatous lesion of the tongue of tuberculous origin, both presented with only a small swelling. Fine-needle aspiration cytology (FNAC) and biopsy proved them to be granulomatous lesions. Antitubercular drugs (ATDs) were started, lesions healed completely without any residual effect.

Keywords: Antitubercular drugs, granuloma, tuberculosis

How to cite this article:
Jain P, Adhikari A, Mandal PK, Minz RS. Tuberculosis of tongue, an enigma: Report of two cases. CHRISMED J Health Res 2019;6:117-8

How to cite this URL:
Jain P, Adhikari A, Mandal PK, Minz RS. Tuberculosis of tongue, an enigma: Report of two cases. CHRISMED J Health Res [serial online] 2019 [cited 2022 Jul 7];6:117-8. Available from: https://www.cjhr.org/text.asp?2019/6/2/117/258969

  Introduction Top

Granuloma is a form of chronic inflammatory disorders, which can occur in almost every organ of our body. Tubercle bacillus is one of the most common causes of granulomatous lesions. Of course, as an organ tongue is an unusual site for granuloma. We present two cases, both of them presented with swelling over the dorsum of the tongue. Fine needle aspiration cytology (FNAC) or biopsy of those lesions proved them to be granuloma. They responded well with antitubercular drugs (ATDs) and disappeared fully without any complication.

  Case Report Top

Case 1

A 55-year-old female presented with an irregular swelling of about 1 cm diameter at the base of tongue [Figure 1]b for the past 6 months. The swelling was suspected as squamous cell carcinoma clinically. Biopsy from the lesion revealed a granulomatous lesion [Figure 2]b. Sputum test for tubercle bacillus was negative. Chest X-ray also was normal. With ATD, the swelling started to reduce in size and ultimately disappeared completely.
Figure 1: (a) Tuberculous lesion on lateral aspect of tongue. (b) Tuberculous lesion on dorsum of tongue

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Figure 2: (a) Fine needle aspiration cytology picture from tongue lesion showing granuloma (LG, ×40). (b) HP picture from tongue lesion showing granuloma (H and E, ×40)

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Case 2

An 18-year-old-female reported with swelling of 0.5 cm diameter at the right lateral side of tongue [Figure 1]a for the past 2 months. FNAC of the swelling disclosed a granulomatous lesion [Figure 2]a. Chest X-ray and Mantoux test were negative. ATD was commenced empirically. The swelling reduced fully 1 month after starting of drugs.

In both the cases, there was no complaint such as pain, dysphagia, or cervical lymphadenopathy. There was also no history of trauma from sharp tooth, ill-fitting denture, etc. Past or contact history for tuberculosis (TB) was not positive too. They were HIV negative and were not receiving any immunosuppressive drug for any other purpose.

In both the cases, ATDs (drugs such as, Isoniazid, Rifampicin, Pyrazinamide, Ethambutol – for the first 2 months, followed by Isoniazid, Rifampicin – for the next 4 months) were given for a total period of 6 months and the patients were cured completely. Six-month period of follow-up after completion of ATD course was uneventful.

  Discussion Top

There are different causes of granulomatous reaction. Starting from bacterium like tubercle bacillus and fungus like Histoplasma, various autoimmune disorders, foreign body, etc., can play a role as an etiological agent for granuloma formation. TB usually affects lungs but the bacilli can reach hematogenously to other organs including oral cavity and can involve tongue also.[1] 20% TB cases affect extrapulmonary organs.[2] In the head–neck region, TB cases are usually seen as cervical lymphadenitis, accounting for 95% of cases.[3] The oral cavity shows 0.2% to 1.5% of all cases of extrapulmonary TB and mostly due to secondary to pulmonary TB.[4] Oral cavity TB is rare due to continuous showering of oral mucosa with saliva and natural resistance of oral mucosa to Mycobacterium bacilli.[5] Relative paucity of lymphoid tissue in the tongue is another protecting factor.[6] In oral TB cases, the tongue being most commonly affected organ.[7],[8] In 1761, Morgagni first described a case of lingual TB.[9] TB of the tongue is commonly seen in immunocompromised patients, males and smokers.[10] Poor oral hygiene and breech of tissue due to trauma are other risk factors.[5] Aird described five pathological types of tuberculous lesion of tongue[11] – (1) Tuberculous ulcer (2) Tuberculoma (3) Tuberculous Fissure (4) Tuberculous papilloma, and (5) Tuberculous cold abscess. Macroglossia is an extremely rare presentation.[6] Clinically, the most common form of lingual TB is ulcer along the lateral border of the tongue.[12] Our cases presented as swelling over the tongue. Low number of cases is probably due to underreporting,[13] along with the varied presentation of the disease leads to dilemma for the clinicians. Investigations suggested for confirmation are FNAC and biopsy of the lesion, particularly to demonstrate the granuloma. Actually, ultimate confirmation is complete response to standard ATDs. Some highly specific techniques like Cartridge based nucleic acid amplification technique and polymerase chain reaction are available now-a-days.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understand that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Pathology Department Bankura Sammilani Medical college, Bankura, West Bengal, India.

Conflicts of interest

There are no conflicts of interest.

  References Top

Jain P, Jain I. Oral manifestations of tuberculosis: Step towards early diagnosis. J Clin Diagn Res 2014;8:ZE18-21.  Back to cited text no. 1
Chiesa Estomba CM, Araujo da Costa AS, Schmitz TR, Lago PV. Base of tongue tuberculosis: A case report. Iran J Otorhinolaryngol 2015;27:239-42.  Back to cited text no. 2
Nalini B, Vinayak S. Tuberculosis in ear, nose, and throat practice: Its presentation and diagnosis. Am J Otolaryngol 2006;27:39-45.  Back to cited text no. 3
Iype EM, Ramdas K, Pandey M, Jayasree K, Thomas G, Sebastian P, et al. Primary tuberculosis of the tongue: Report of three cases. Br J Oral Maxillofac Surg 2001;39:402-3.  Back to cited text no. 4
Parajuli R, Maharjan S. Tubercular ulcer of tongue in an elderly patient masquerading as a traumatic ulcer. Case Rep Otolaryngol 2017;2017:8416963.  Back to cited text no. 5
Yadav SP, Agrawal A, Gulia JS, Singh S, Gupta A, Panchal V. Tuberculoma of the tongue presenting as hemimacroglossia. Case Rep Med 2012;2012:548350.  Back to cited text no. 6
Jaward J, El Znebi F. Primary lingual tuberculosis: A case report. J Laryngol Otol 1996;110:1778-80.  Back to cited text no. 7
Miziara ID. Tuberculosis affecting the oral cavity in Brazilian HIV-infected patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100:179-82.  Back to cited text no. 8
Jawad J, El-Zuebi F. Primary lingual tuberculosis: A case report. J Laryngol Otol 1996;110:177-8.  Back to cited text no. 9
Kumar V, Singh AP, Meher R, Raj A. Primary tuberculosis of oral cavity: A rare entity revisited. Indian J Pediatr 2011;78:354-6.  Back to cited text no. 10
Khatri BK, Jhalla GS. Tuberculosis of tongue: A case report. Indian J Tuberc 1971;18:58-9.  Back to cited text no. 11
Kakisi OK, Kechagia AS, Kakisis IK, Rafailidis PI, Falagas ME. Tuberculosis of the oral cavity: A systematic review. Eur J Oral Sci 2010;118:103-9.  Back to cited text no. 12
Ramesh V. Tuberculoma of the tongue presenting as macroglossia. Cutis 1997;60:201-2.  Back to cited text no. 13


  [Figure 1], [Figure 2]

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