Mycobacterium tuberculosis as a cause of mandibular osteomyelitis in a young woman: a case report

Abstract

Background: Tuberculosis is considered an emerging disease worldwide; in the last 10 years, its incidence has increased to more than 9.6 million cases of active tuberculosis. In 2014, it resulted in 1.5 million patient deaths. However, oral presentation with bone involvement occurs in less than 3% of all reported cases and rarely arouses clinical suspicion on initial presentation.

Case presentation: A 15-year-old Mexican girl who had a previous diagnosis of neurofibromatosis presented to our hospital with pain and swelling in the region of the left mandibular body since November 2011. A clinical examination revealed pain in the mandibular region, a mass of soft consistency that seemed to involve bone, and a fistula with discharge of intraoral purulent material. Additionally, tachycardia and hyperthermia were observed. The left submental and submandibular regions had a 12-cm-diameter swelling, which was well-delineated and nonerythematous. The final diagnosis was established by real-time polymerase chain reaction.

Conclusions: The final diagnosis of rare cases of tuberculous osteomyelitis in the jaw can be established by deoxyribonucleic acid (DNA) identification of Mycobacterium tuberculosis in the lesion. Simple and fast complementary diagnosis by real-time polymerase chain reaction is a fundamental approach to establishing early and effective pharmacological and surgical treatment.

Keywords: Case report; Jaw; Mycobacterium tuberculosis; Osteomyelitis; Tuberculosis.

Fig. 1

Clinical imaging of our patient with tuberculous osteomyelitis in the left mandible showing left-sided cheek swelling. (a) Frontal and (b) lateral views displaying mandible tuberculosis symptoms. (c) Frontal and (d) lateral views of three-dimensional reconstruction by computed tomography showing erosion and perforations of the cortical periosteal bone

Fig. 2

Technetium-99 m-ciprofloxacin accumulation in the mandible. Images show an abnormal concentrated area of radiolabeled antibiotic at the level of the left mandible, suggesting an infectious disease process. (a) Frontal view. (b) Oblique view. (c) Lateral view. The arrows indicate the site of 99mTc-Ciprofloxacine accumulation

Fig. 3

Macroscopic and histological characteristics of jaw and real-time polymerase chain reaction-based diagnosis. a Macroscopic characteristics of inner side of jaw. Large eroded areas accompanied by bleeding and bone decalcification can be seen. b Histopathological characteristics. Extensive chronic osteomyelitis process can be seen. c Molecular diagnosis of tuberculous osteomyelitis of the jaw. Both markers, susceptible Mycobacterium tuberculosis and M. tuberculosis-positive control, conformed to the M. tuberculosis diagnosis. S-MTB Susceptible Mycobacterium tuberculosis biopsy patient sample positive for Mycobacterium tuberculosis, MTB-(C+) Mycobacterium tuberculosis-positive control, NTM-(C+) Nontuberculous mycobacteria-positive control, IC Internal control, NC Negative control