Secondary tuberculosis of tongue in an HIV-infected patient

Abstract

Background. Mycobacterium tuberculosis infection is a chronic granulomatous disease, which may present with a broad spectrum of pulmonary and/or extrapulmonary manifestations. The latter are rare, accounting for 10%-15% (oral cavity, 0.05%-5%) of all cases, most often being secondary to pulmonary involvement. Recently, HIV infection has been deemed as a potent factor in promoting the development of tuberculosis.Case report. A 40-year-old male complained of painful ulcers and burning sensation on his tongue. His medical history revealed HIV infection, Kaposi's sarcoma of the extremities, thrombocytopenia, and hypertension. He denied symptoms of fever, coughing, and weight loss. His social history included smoking cigarettes. Oral examination revealed 2 ulcerative lesions on the tip and right lateral border of the tongue respectively, which were shallow with elevated, irregular, nonindurated borders. In addition, white wipeable plaques were present diffusely on his tongue mucosa. Owing to his thrombocytopenia, a biopsy was contraindicated. An initial diagnosis of ulceration not otherwise specified and pseudomembranous candidiasis associated with HIV infection was rendered, and the patient was treated with topical corticosteroids and antifungal medication. However, the ulcerative lesions dramatically enlarged and became more symptomatic, despite additional empirical treatment with acyclovir, thalidomide, and erythromycin mouthwash. After platelet transfusion, a biopsy was performed which revealed granulomatous inflammation with numerous multinucleated Langhans-type giant cells. Tissue section stained with Zeihl-Neelson showed acid-fast bacilli, supporting the diagnosis of tuberculosis. A complete medical examination and chest radiograph confirmed the presence of pulmonary tuberculosis. The patient received antituberculosis drugs (pyrazinamide and isoniazid), which induced complete healing of his tongue ulcers.Conclusions. Oral lesions in HIV-infected patients may represent manifestations of uncommon systemic diseases. Tuberculosis should be included in the differential diagnosis of nonhealing oral ulcers in an HIV-infected patient. Extrapulmonary lesions in patients infected with HIV may be the first detected sign of undiagnosed pulmonary tuberculosis. Background. Mycobacterium tuberculosis infection is a chronic granulomatous disease, which may present with a broad spectrum of pulmonary and/or extrapulmonary manifestations. The latter are rare, accounting for 10%-15% (oral cavity, 0.05%-5%) of all cases, most often being secondary to pulmonary involvement. Recently, HIV infection has been deemed as a potent factor in promoting the development of tuberculosis. Case report. A 40-year-old male complained of painful ulcers and burning sensation on his tongue. His medical history revealed HIV infection, Kaposi's sarcoma of the extremities, thrombocytopenia, and hypertension. He denied symptoms of fever, coughing, and weight loss. His social history included smoking cigarettes. Oral examination revealed 2 ulcerative lesions on the tip and right lateral border of the tongue respectively, which were shallow with elevated, irregular, nonindurated borders. In addition, white wipeable plaques were present diffusely on his tongue mucosa. Owing to his thrombocytopenia, a biopsy was contraindicated. An initial diagnosis of ulceration not otherwise specified and pseudomembranous candidiasis associated with HIV infection was rendered, and the patient was treated with topical corticosteroids and antifungal medication. However, the ulcerative lesions dramatically enlarged and became more symptomatic, despite additional empirical treatment with acyclovir, thalidomide, and erythromycin mouthwash. After platelet transfusion, a biopsy was performed which revealed granulomatous inflammation with numerous multinucleated Langhans-type giant cells. Tissue section stained with Zeihl-Neelson showed acid-fast bacilli, supporting the diagnosis of tuberculosis. A complete medical examination and chest radiograph confirmed the presence of pulmonary tuberculosis. The patient received antituberculosis drugs (pyrazinamide and isoniazid), which induced complete healing of his tongue ulcers. Conclusions. Oral lesions in HIV-infected patients may represent manifestations of uncommon systemic diseases. Tuberculosis should be included in the differential diagnosis of nonhealing oral ulcers in an HIV-infected patient. Extrapulmonary lesions in patients infected with HIV may be the first detected sign of undiagnosed pulmonary tuberculosis.