Pediatric Primary Tuberculous Osteomyelitis of the Mandible Mimicking Parotitis

Abstract

Tuberculosis (TB) is a worldwide public health problem; however, primary tuberculous osteomyelitis involving the mandible is extremely rare. Here, we report a 14-year-old boy who presented with a recurrent, generalized swelling of the cheek in the right side, mimicking parotitis. Fine needle aspiration cytology (FNAC) from the swelling was inconclusive. Contrast-enhanced computed tomography (CECT) of the head and neck revealed an osteolytic lesion of the mandible with a surrounding abscess. An intraoral incisional biopsy of the tissue showed a granulomatous lesion. The patient was started on anti-tubercular therapy (ATT) for six months. Our patient's presentation underscores the clinical difficulty in establishing a diagnosis and considering tuberculous osteomyelitis in the differential diagnosis.

Keywords: lymphadenitis; mandible; osteomyelitis; parotitis; tuberculosis.

Figure 1. Diffuse swelling of the right side of the cheek with submandibular region involvement

Figure 2. a) Contrast-enhanced computed tomography head axial view showing irregularly thickened cortex with loss of corticomedullary junction with multiple loosened areas showing a breach of the cortex and periosteal reaction (white arrow) with adjacent soft tissue component. b) Showing central hypoattenuation areas representing central necrosis (black arrow) with periosteal reaction

Figure 3. Intraoral photograph of the right mandibular region showing the biopsy site (black arrow)

Figure 4. Histopathological picture (hematoxylin and eosin stain, 400x magnification) is showing an epithelioid cell granuloma with characteristic Langhans Giant cells (black arrow) surrounded by lymphocytes and plasma cells