Tongue Tuberculosis as a Complication of Pott's Disease in a Patient on Systemic Steroid Therapy without Pulmonary Tuberculosis

Abstract

A 78-year-old man with a previous diagnosis of rheumatoid arthritis on prolonged treatment with corticosteroids presented with intense and progressive pain at the cervical level that prevented him from resting his head and walking, in addition to an ulcerative lesion covering 80% of the lingual area that was previously treated as oral candidiasis without improvement. On arrival, with no clinical or serological data of rheumatoid arthritis, immunosuppressive treatment was suspended, and a biopsy of the oral cavity was requested, confirming the diagnosis of lingual tuberculosis, an extremely rare disease, occurring in less than 1% of extrapulmonary cases. MRI of the cervical spine showed a crush fracture of the C6 and C7 bodies associated with spondylitis of probably infectious etiology that required surgical treatment, and histopathological studies confirmed Pott's disease. The patient displayed no evidence of pulmonary tuberculosis from arrival until the end of the follow-up.

Keywords: Pott’s disease; case report; mycobacterium infections; tongue tuberculosis; tuberculosis.

Figure 1

Ulcerative tongue lesions secondary to TB.

Figure 2

(A,B): Multinucleated Langerhans-type giant cells (L-G) and Necrosis Zones (NZs) on hematoxylin–eosin staining. (C,D): Caseating granulomas and Koch Bacilli (KB) on Ziehl–Neelsen stain. SEC: Squamous Epithelium of Oral Cavity. Black Arrows: Koch Bacilli.

Figure 3

(A): Lateral X-ray of the cervical spine showing crushing of the C5 and C6 vertebral bodies. (B): Simple MRI up to T6, showing crushing of the C6 and C7 cervical bodies. (C): Anterior cervical spine fixation with threaded basket and automatic titanium locking.

Figure 4

Ulcerative tongue lesion 6 months (A) and 12 months (B) after the pharmacological treatment.