Primary tuberculous osteomyelitis of the mandible in a 3-year-old child

Abstract

A 3-year-old girl child presented with swelling in her right lower jaw that had started 5 days previously. History revealed the child being non-immunised. Initial-evaluation revealed proptosis and bony hard swelling over the right body of the mandible. Radiological evaluation including a CT scan indicated expansile osteolytic lesion involving the body-ramus with onion-peel periosteal reaction suggesting osteomyelitis/malignancy. Blood investigations showed raised erythrocyte sedimentation rate and eosinophilia. Family screening for tuberculosis (TB) revealed that the patient, her father and siblings were PPD positive though chest screening and sputum examinations were negative in all of them. Lesion biopsy showed acute/chronic osteomyelitis with eosinophilia, tilting diagnosis towards eosinophilic granuloma/Hand-Schuller-Christian disease. Further investigations for diabetes insipidus, histiocytosis-X, skull-pelvic-femur radiographs, abdominal ultrasonography, ophthalmic consultation and PCR-TB test were negative. Histology, radiography, purified protein derivative (PPD)-positive result and history led to the diagnosis of primary TB of the mandible. Complete resolution occurred following antitubercular therapy. The case report emphasises that diagnosis of TB can sometimes be based on circumstantial evidence and positive response to antitubercular therapy even in view of a negative PCR result.

Tuberculous osteomyelitis of the mandible impersonating dentoalveolar abscess: a case report

“…Orofacial tuberculosis may be primary, or secondary to pulmonary tuberculosis. Secondary TB is more common in adults or geriatric cases, whereas primary oral TB generally affects younger patients [3]. Tuberculous osteomyelitis is uncommon and forms <2% of skeletal tuberculosis.…”

“…TB osteomyelitis generally presents as swelling, pain, loosening of teeth and draining sinuses like a tooth abscess. Radiographic features are similar to chronic suppurative osteomyelitis i.e., diffuse radiolucency and altered trabecular pattern [1,[3][4][5]. Other maxillofacial manifestations of TB include an ulcer, granulomas, involvement of salivary glands and temporomandibular joint, and tuberculous lymphadenitis [6].…”

Mandibular tuberculosis fortuitously discovered after surgical resection of an ameloblastoma: A case report

“…The lesions of primary orofacial tuberculosis could be the only presentation of the disease; however orofacial tuberculosis is usually associated with systemic manifestations of tuberculosis. [4] …”

“…Primary tuberculosis of the oral cavity is very rare .The mandibular localization of tuberculosis is rare and represents less than 2% of the skeletal locations [1] , [2] , [3] . The lesions of primary orofacial tuberculosis could be the only presentation of the disease; however the orofacial presentation is usually associated with systemic manifestations of tuberculosis [4] . Mandibular tuberculosis presents often a difficulty of diagnosis because of the rarity and non-specificity of clinical presentation and the absence of pathognomonic signs.…”

Pediatric Primary Tuberculous Osteomyelitis of the Mandible Mimicking Parotitis

“…Sambyal SS et al reported various radiological features of tuberculous osteomyelitis [ 8 ]. In the present patient, CECT head and neck revealed the presence of an ill-defined osteolytic lesion involving the mandibular body, suggestive of osteomyelitis.…”