Perforation of the hard palate due to tuberculosis

Abstract

Tuberculosis (TB) of the hard palate is rare and usually secondary to pulmonary TB. We present a case of a 7-year-old boy who presented with difficulty in swallowing solid foods, low-grade fever and loss of weight. Oral cavity examination showed perforation of the hard palate with an irregular, undermined margin and a necrotic base. Chest X-ray showed homogeneous opacity in the right upper zone. Fine-needle aspiration of the cervical lymph nodes showed granular caseous necrosis and granuloma composed of epitheliod cells and histiocytes. In view of the clinical presentation and evidence of pulmonary and lymph node TB, the palatal perforation was most likely due to TB. Patient was started on antituberculous therapy and is on regular follow-up.

Keywords: Hard palate; perforation; pulmonary tuberculosis; tuberculosis.

Figure 1

Oral cavity examination showing perforation of the hard palate, 3 × 3 cm in size with an irregular, undermined margin, and a necrotic base

Figure 2

Plain axial computed tomography scan of midface with 3D reconstruction showing erosion and scalloping of the posterior part of the hard palate on the right side

Figure 3

High power view of papanicolaou stain of fine needle aspiration of the cervical lymph nodes showing granular caseous necrosis and granuloma composed of epithelioid cells and histiocytes