Vidal M, Delevaux I, André M, Marroun I, Gavet F, Voinchet H, Palat S, Kintossou R, Gilain L, Aumaître O
Service de médecine interne, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 58, rue Montalembert, BP 69, 63003 Clermont-Ferrand cedex 01, France.
Rev Med Interne. 2007 Feb;28(2):124-6. doi: 10.1016/j.revmed.2006.11.009. Epub 2006 Nov 27.
Tuberculous lesions of the oral cavity are uncommon. Most of cases are secondary to pulmonary disease and the primary form is rare.
We report the case of a 64 year-old man, smoker, presenting a chronic ulcer of the tongue, with anorexia and important weight loss. The biopsy of this ulcer showed granulomatous inflammation and Langhans type giant cells, without necrosis. Ziehl-Nielsen stain was negative. Pulmonary lesions were subsequently detected (chest X-ray, CT-scan) and the disseminated tuberculosis was confirmed by a positive culture with acid-fast bacilli in urine, blood, and pulmonary sample. Antituberculosis treatment resulted in the complete resolution of the oral lesion.
Biopsy for histopathological diagnosis, acid-fast stains and culture, is essential to determine the exact nature of chronic oral ulceration to distinguish between oral malignancy, infectious (syphilis), traumatic, or aphthous ulcers. Tuberculosis of the tongue is a difficult diagnosis. However it should be searched for because treatment usually results in a rapid recovery.
口腔结核病变并不常见。大多数病例继发于肺部疾病，原发性形式罕见。
我们报告了一例64岁男性吸烟者的病例，该患者舌部有慢性溃疡，伴有厌食和显著体重减轻。该溃疡的活检显示肉芽肿性炎症和朗汉斯型巨细胞，无坏死。齐-尼氏染色为阴性。随后检测到肺部病变（胸部X光、CT扫描），尿液、血液和肺部样本中抗酸杆菌培养阳性证实为播散性结核。抗结核治疗使口腔病变完全消退。
进行活检以进行组织病理学诊断、抗酸染色和培养，对于确定慢性口腔溃疡的确切性质至关重要，以区分口腔恶性肿瘤、感染性（梅毒）、创伤性或阿弗他溃疡。舌结核诊断困难。然而，应进行排查，因为治疗通常会使病情迅速恢复。
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