A 49-year-old male was referred to our department with the complaint of painful and non-healing ulcer of the tongue for 4 months. There was no history of fever, night sweats, cough, decreased appetite and weight loss. He did not give any history of traumatic episode preceding the development of tongue ulcer. He denied any history of similar lesions in the past. He is an occasional smoker. The rest of his medical and surgical history was unremarkable. His dental history was not significant. There was no history of TB in his family members. He was repeatedly treated in a government hospital with topical antiseptics and oral antibiotics (ampicillin plus cloxacillin and metronidazole) and analgesics, but the lesion did not subside so he was referred to our hospital for the further management. On general examination, he was of average built. Intraoral examination revealed an indurated ulcer measuring 1.5 cm × 1.0 cm on the left dorsolateral border of anterior part of tongue. It was tender on palpation with irregular borders and did not bleed on touch. The remaining part of the tongue appeared normal in texture and color. Mobility of the tongue was normal. He had poor oral hygiene along with sharp tooth in relation to 34. There were no palpable cervical lymph nodes. Provisional diagnosis of chronic traumatic ulcer was made as the possibility of ulcer due to repeated trauma by the sharp tooth. Chest X-ray did not reveal any evidence of active lesion. Sputum for AFB was negative on Ziehl–Neelsen stain. Complete blood count was within normal limit. His ESR value was 20 mm/hr. Serum biochemistry and renal function tests were within normal limits. Serological investigation for human immune deficiency virus (HIV) was negative. Coronoplasty of adjacent sharp cusps was done, and since the ulcer presented for more than 2 months, an incisional biopsy was taken under local anesthesia containing an ulcerated lesion along with the normal looking margin and the specimen was sent for HPE. Microscopically, the lesion revealed the stratified squamous epithelium with granulomatous inflammation containing Langhans-type giant cells, epithelioid cells and foci of caseous necrosis, strongly suggestive of TB. The patient was then started on ATT. The ulcer gradually started fading once drug therapy was started (ATT) and the tuberculous ulcer healed completely by the 2 months of ATT containing isoniazid, rifampicin, pyrazinamide and ethambutol. The patient was advised to continue ATT containing isoniazid and rifampicin for another 4 months. At the end of total 6 month's ATT course, there was no evidence of ulcer at the primary site.
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.