Tuberculosis cutis orificialis with both gingival involvement and underlying pulmonary tuberculosis

Tuberculosis cutis orificialis is a rare manifestation of cutaneous tuberculosis which occurs in the oral, perianal and adjacent mucosa. The most frequent orificial lesion location is the tongue. We report a case of a 35-year-old female with tuberculosis cutis orificialis with gingival involvement. She had a six-month history of a moderately painful gingival ulceration. Histopathological examination showed granulomatous infiltrates composed of epithelioid cells, Langhans giant cells and caseating necrosis. A purified protein derivative test was positive. Sputum culture was positive for Mycobacterium tuberculosis. Chest X-ray and high resolution computed tomography showed active pulmonary tuberculosis in both upper lung zones. The gingival specimen was positive for M. tuberculosis polymerase chain reaction. A complete resolution was achieved after six months of anti-tuberculosis therapy. Dental identification of M. tuberculosis may serve as an important aid in the first line of control of this dangerous infectious disease.