Etiology • Mycobacterium tuberculosis usually; less commonly M. avium-
intracellulare • Oral lesions form in relation to extension of disease beyond
the pulmonary focus • Increased incidence in immunocompromised patients
Clinical Presentation • Chronic, nonhealing ulcer with induration • Borders may be raised or rolled. • Intrabony lesions are lytic and sequestrate with radiographic
features of osteomyelitis. Microscopic Findings
• Centrally necrotic granulomas with peripheral multinucleated Langhans’ giant cells
intracellulare • Oral lesions form in relation to extension of disease beyond
the pulmonary focus • Increased incidence in immunocompromised patients
Clinical Presentation • Chronic, nonhealing ulcer with induration • Borders may be raised or rolled. • Intrabony lesions are lytic and sequestrate with radiographic
features of osteomyelitis. Microscopic Findings
• Centrally necrotic granulomas with peripheral multinucleated Langhans’ giant cells
• Positive Fite or Ziehl-Neelsen tissue staining of microorganisms Diagnosis
• Clinical appearance and lesion persistence • Histopathology • Tuberculin skin test; two-step Mantoux test • Culture
Differential Diagnosis • Squamous cell carcinoma • Syphilis • Deep mycotic infection • Traumatic eosinophilic ulcer • Lymphoma
Treatment • Systemic chemotherapy: isoniazid, rifampin, streptomycin, and
others • Note: Multidrug-resistant organism may be present.
Prognosis • Good • In the immunosuppressed patient, prognosis is fair.