lingual tuberculosis in an hiv aids patient

Accepted ManuscriptTitle: Lingual tuberculosis in an HIV/AIDS Patient Authors: Jos´e Y.. Lingual tuberculosis in an HIV/AIDS Patient Article's reference number IJID 2892 List of Authors

Accepted Manuscript

Title: Lingual tuberculosis in an HIV/AIDS Patient

Authors: Jos´e Y Rodr´ıguez, Gerson J Rodr´ıguez, Carlos A

´Alvarez-Moreno

DOI: http://dx.doi.org/doi:10.1016/j.ijid.2017.03.003

To appear in: International Journal of Infectious Diseases

Received date: 3-1-2017

Revised date: 24-2-2017

Accepted date: 1-3-2017

Please cite this article as: Rodr´ıguez Jos´e Y, Rodr´ıguez Gerson J, ´Alvarez-Moreno

Carlos A.Lingual tuberculosis in an HIV/AIDS Patient.International Journal of Infectious Diseaseshttp://dx.doi.org/10.1016/j.ijid.2017.03.003

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Lingual tuberculosis in an HIV/AIDS Patient

Article's reference number IJID 2892

List of Authors and affiliations

José Y Rodríguez MD 1

Gerson J Rodríguez MD 1

Carlos A Álvarez-Moreno MD 2

1 Centro de Investigaciones Microbiológicas del Cesar (CIMCE) Hospital Rosario Pumarejo de López Clínica Laura Daniela and Clínica Médicos LTDA Valledupar, Colombia

2 Universidad Nacional de Colombia, Facultad de Medicina and Clínica

Universitaria Colombia, Colsanitas Bogotá, Colombia

Keywords: oral ulcers, tongue tuberculosis, lingual tuberculosis, Oral

tuberculosis, HIV Infections, Mycobacterium tuberculosis

Highlights

 Oral Tb should be included in the differential diagnosis of oral lesions, irrespective of the existence of pulmonary signs and symptoms

 The diagnosis of oral Tb is difficult and can be performed by pathological examination and PCR assays

A 45-year-old man presented with a 6 months’ history of a painless persistent ulcer in the tip of the tongue, with slightly elevated margin The lesion worsens to compromise the distal third of the tongue (A) The patient did not smoke or drink alcohol and he has a history of HIV infection, non-adherent to antiretroviral therapy (viral load of HIV1 RNA 31189 copies and CD4+ T cell count of

200 cells/mm3) Incisional biopsy of the indurated upper border in apex showed central necrotic tissue and chronically inflamed granulation with epithelioid cells (B) Acid fast bacilli weren’t identified in Ziehl-Neelsen staining IS6110 real-time

PCR for detection of Mycobacterium tuberculosis complex in DNA extracted from

formalin-fixed paraffin embedded was positive Anti-TB drug regimen of isoniazid, rifampicin, pyrazinamide, and ethambutol was prescribed with adequate clinical response (C)

Oral tuberculosis is a rare entity accounts for 0.1-1.5% of extrapulmonary TB cases (1) May be primary, which are rare and occur as a result of the direct inoculation of oral tissues, or secondary, due to hematogenous or lymphatic dissemination and extensions of nearby structures In this case we consider that

it is a post-primary Tb since it is the most common presentation (2) They present

as ulcers, nodules, tuberculomas, fissures o periapical granulomas May occur at any location on the oral mucosa, but the tongue is most commonly affected (2) The differential diagnosis includes traumatic or aphthous ulcers, actinomycosis, syphilitic ulcer, mycotic infections, Wegener's granuloma, sarcoidosis, Crohn's disease and malignancy (3)

1 Nemes RM, Ianosi ES, Pop CS, Postolache P, Streba CT, Olteanu M, et

al Tuberculosis of the oral cavity Rom J Morphol

Embryol 2015;56(2):521-5

2 Kakisi OK, Kechagia AS, Kakisis IK, Rafailidis PI, Falagas ME

Tuberculosis of the oral cavity: a systematic review Eur J Oral Sci 2010

Apr;118(2):103-9

3 Gharebaghi N, Monsouri SA, Darazam IA, Mansouri D, Sajadi MM,

Mansouri N A 40-year-old man with tongue lesions Lingual and

pulmonary tuberculosis (TB) Clin Infect Dis 2011 May;52(10):1231, 1276-7

Ethics statement: Written informed consent was obtained from the patient for

the publication of this case report

Conflict of interest: None of the authors report a conflict of interest, and there

were no funding sources All of the authors have submitted the ICMJE Form for the Disclosure of Potential Conflicts of Interest

Figure 1: A: Photograph of the patient's tongue showing ulcer in the tip of the tongue B: Hematoxylin eosin staining C: Clinical response 8 months after

treatment