A Rare Presentation of Tuberculosis of the Palate

Abstract

Background: Oral manifestations of tuberculosis (TB) are uncommon, accounting for only 0.1-5% of all TB cases. Among these, lesions on the hard palate are especially rare, representing the primary site in just 5% of oral TB cases. Case Presentation: A 28-year-old female, originally from the Philippines and residing in the UK since 2013, presented with an unusual erythematous lesion on her hard palate. She had been concerned about a large, painful lesion that had persisted for two years. Clinical examination revealed a granulomatous lesion on the hard palate, which was erythematous and inflamed. Additionally, flexible laryngoscopy showed a similar erythematous appearance on the posterior pillar of the fauces. Investigations included blood tests, radiological imaging, and histopathology. A T-spot test returned positive for TB. Chest X-ray was unremarkable, and a CT scan of the facial bones showed asymmetry of the hard palate without signs of malignancy. Biopsy of the palatal lesion revealed ulceration with dense plasmacytic aggregates and necrotizing granulomatous inflammation. Acid-fast bacilli were identified on Ziehl-Neelsen stain, confirming the diagnosis of TB. Laryngeal TB was also diagnosed based on positive TB PCR and sputum culture results from the respiratory team. Conclusion(s): This case highlights the importance of maintaining a broad differential diagnosis, particularly for uncommon presentations of diseases like oral TB. It underscores the value of a systematic approach to patient evaluation and the essential role of histopathology in diagnosing oral TB.Copyright © 2025