Oral Ulcer as the First Sign of Miliary Tuberculosis: A Case Report

Abstract

Tuberculosis is a chronic granulomatous disease that usually involves the lungs. However, any part of the body can be affected. A 34-year-old male presented an ulcerated lesion in oropharynx and complained of dysphagia. The lesion had appeared 1 year before and increased recently, affecting multiple sites. Cervical lymphadenopathy was also present. Lately, he had severe weight loss and regular fever. The diagnostic hypotheses included Wegener's granulomatosis and tuberculosis. Histopathological examination of the oral lesion revealed several granulomas with Langhans giant cells. Several acid-fast bacilli were identified with Fite–Faraco stain. Examination of the pulmonary and lymph node biopsy specimens produced similar findings, indicating miliary tuberculosis. The patient received anti-tuberculosis therapy but died a few weeks later. Although uncommon, oral tuberculosis can be the first sign of a severe systemic infection. This case highlights the importance of an accurate diagnosis.