A 63-year-old male farmer of a suburban area came to the otorhinolaryngology outpatient department of our hospital with complaints of a painless ulcer in the oral cavity for 10 days and pain in both the ears and throat for 3 days. On local examination, a painless ulcer measuring 1.8 cm in greatest diameter with irregular, friable margin and bleeding on touch was found affecting the left alveolar mucosa, involving premolar and molar region and extending laterally into the gingivolabial sulcus and medially into the soft palate (Figure 1). Only the incisors, canine, and the first premolar teeth were intact on the affected side, and the throat was congested. A clinical diagnosis of cancer of the left alveolus in the oral cavity was made; an incisional biopsy was taken from the margin of the ulcer and sent for histopathological examination. Routine hematological and biochemical investigations and the chest X-ray did not reveal any abnormality. No radiographic evidence of involvement of underlying bone was seen. Serological tests done for syphilis and HIV were found negative.
Microscopic examination showed stratified squamous epithelium and subepithelium revealing crushing artifacts with presence of multiple necrotizing epithelioid cell granuloma and Langhans' type of giant cell (Figure 2). Ziehl-Neelsen stain of the tissue showed many acid fast bacilli (Figure 3). Malignancy was not seen in serial section examined. Silver stain done on the section did not show spirochetes or fungi. On the basis of above findings, a diagnosis of tuberculosis of left upper alveolus was made. Subsequent history taken after the diagnosis, revealed history of exodontias, one month back of the presentation of an ulcer and occasional use of raw milk. There was no family history of tuberculosis.
The patient was treated with multidrug antitubercular regimen. The drug given for initial two months were isoniazid 400 mg, rifampicin 600 mg, ethambutol 750 mg, and streptomycin 1000 mg. The ulcerative lesion was completely healed after 2 months of therapy. The drugs isoniazid 400 mg and rifampicin 600 mg were continued for further four months. No recurrence was observed in the follow-up period of a two-year duration after the completion of full-course multidrug regimen.