A 65-year-old male presented to us with a painful, progressively increasing swelling of the tongue of 8 months duration. There was no history of cough, fever, dysphagia, or weight loss. He was a nonsmoker, but a tobacco chewer for the past 15 years. He was an alcoholic since past 15 years. He was not a known case of diabetes mellitus, but a hypertensive since past 4 years and was on regular treatment for it. On examination, patient was well built with good general condition. Examination of oral cavity revealed an 8 × 6 cm firm swelling over the left side of anterior 2/3rd of tongue, crossing the midline, with smooth surface and well-defined margins. The lesion apparently looked like hemimacroglossia (). There was no deviation of tongue, with all movements being normal. No lymphadenopathy was found in the neck. Systemic examination did not reveal any abnormal findings. Clinical suspicion of submucosal carcinoma of tongue was entertained. Complete blood count was within normal limits. ESR was found raised to 35 mm in first hour. A deep punch biopsy from lateral aspect of the lesion was taken, which revealed granulomatous inflammation suggestive of tuberculosis (). Acid fast bacilli were found in Ziehl-Neelsen stained sections (). A histopathological diagnosis of tuberculosis was made. Mantoux test performed with PPD antigen measured 18 mm after 72 hours reading. ELISA test for HIV was nonreactive. Chest X-ray was within normal limits. With a final diagnosis of primary tuberculoma of tongue, patient was started on antitubercular therapy with a four drug regimen for 6 months. Dramatic improvement was observed within 2 months of therapy. Size of the lesion was significantly reduced, from an apparent hemimacroglossia to a small nodular lesion. After 6 months the patient was completely cured and is on regular followup with no residual or recurrent lesion.
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.