A 37-year-old female reported to the department of oral medicine and radiology with a chief complaint of nonpainful swelling of the upper anterior gingiva for the past 8 months. The gingiva increased gradually in size with time. The patient had a history of weakness over the past 3–4 months, loss of appetite and loss of weight of about 5 kg during the past 3 months. Her medical history revealed no systemic problems, no cough with expectoration, no known history of contact with a tuberculous patient and no history of dental trauma or any surgery in the affected area. On examination, she was of average built, pulse, temperature and respiration rates were normal. Extraoral examination revealed no cervical lymphadenopathy. Intraoral examination showed diffuse enlargement of labial maxillary gingiva (marginal and attached gingiva) and alveolar mucosa extending from tooth number 13–23. The gingiva was red, irregular, pebbled and granular in appearance with surface ulceration []. On palpation, the swelling was slightly tender, firm and had a tendency for bleeding on provocation. The rest of the OC was normal. Complete hemogram and IOPA radiograph of 11, 12, 21 and 22 were advised. Results were within normal limits, except for a marginal rise in leukocyte count and an elevated erythrocyte sedimentation rate (ESR). IOPA radiograph revealed interdental bone loss in relation to 11 and 21. The patient was then advised tuberculin test, chest X-ray and sputum culture. A tuberculin (Mantoux) test was positive, suggesting tubercular infection. Chest radiography (posteroanterior view) revealed no abnormalities []. Culture of sputum was negative for M. tuberculosis. An incisional biopsy from the maxillary labial gingiva adjacent to the central incisors was performed. Histopathological examination revealed clusters of epithelioid cells, caseating necrosis and numerous Langhans-type giant cells surrounded by a chronic inflammatory type of infiltrate [Figure and ]. In view of these findings, a working diagnosis of primary tuberculous gingival enlargement was made. The patient was later administered antitubercular regime, and within 2 months of therapy, the lesion healed spontaneously []. No recurrence was observed even after 6 months of follow-up. During this period, the patient was instructed not to undergo any surgical procedure within the OC. Further, conservative periodontal therapy, which included scaling and root planning, was carried out with minimal trauma to gingival and after consulting the physician in-charge.
A 33-year-old black female attended the oral medicine clinic at the Medunsa Oral Health Centre, University of Limpopo, complaining of a painful sore on the upper left labial mucosa of about 3 weeks duration. She appeared to be in good health. The patient did not smoke or drink alcohol, and she claimed to be HIV-seronegative as she had been tested for HIV infection about three months previously.\nThere were two ulcers surrounded by a wide area of erythema, one on the upper left labial mucosa that was painful, and one on the ventral surface of the tip of the tongue (). The margins of both ulcers were slightly elevated and indurated. The dorsal surface of the anterior margin of the tongue was hyperaemic with a lobulated appearance ().\nHistological examination of the labial mucosal ulcer showed necrotic tissue and chronically inflamed granulation tissue. Scattered epithelioid cells were present, and Ziehl-Neelsen staining revealed the presence of acid fast bacilli leading to the final diagnosis of oral tuberculosis (Figures and ).\nThe patient was referred to the Department of Internal Medicine at the Dr. George Mukhari Hospital. She proved to be HIV-seropositive with a CD4+ T cell count of 429 cells/mm3. The general physical examination was unremarkable, the chest radiograph did not show any evidence of tuberculosis, and other laboratory investigations that were deemed necessary were all within the range of normality. A nine-month anti-TB drug regimen of isoniazid, rifampicin, pyrazinamide, and ethambutol, was prescribed.\nThe patient did not receive antiretroviral treatment for a reason to be explained below.\nFour weeks after initiation of the anti-TB treatment the oral lesions were strikingly improved (Figures and ), and 8 weeks later the previously affected lip and tongue looked normal.