Pogrešna dijagnoza tuberkuloze usne šupljine kao prekancerozne lezije

Autor: Božena Lončar Brzak, Dragana Gabrić, Emilija Marunica, Ana Glavina, Krešimir Gršić, Ljiljana Smiljanić Tomičević, Vanja Vučićević Boras, Božena Šarčević, Sven Seiwerth
Rok vydání: 2017
Předmět:
Zdroj: Acta stomatologica Croatica : International journal of oral sciences and dental medicine
Volume 51
Issue 4
Acta Stomatologica Croatica
Acta Stomatologica Croatica, Vol 51, Iss 4, Pp 326-331 (2017)
ISSN: 1846-0410
0001-7019
DOI: 10.15644/asc51/4/7
Popis: Svrha ovog prikaza slučaja bila je opisati vrlo rijetku oralnu leziju kao posljedicu primarne plućne tuberkuloze. Prikaz slučaja: Opisan je bolesnik s refraktornom bezbolnom ulceracijom ventralne površine jezika. Pacijentu je uzeta detaljna medicinska anamneza te obavljen klinički pregled sluznice usne šupljine i palpacija regionalnih limfnih čvorova. Kliničkim pregledom ustanovljena je ulceracija na ventrolateralnoj površini jezika promjera oko dva centimetra. Palpacijom regionalnih limfnih čvorova nije otkriveno njihovo povećanje. Toluidinski test sumnjive lezije učinjen je tijekom svakoga kontrolnog pregleda. Biopsijski uzorci za histopatološku analizu uzeti su tri puta. Histopatološka analiza prvoga biopsijskog uzorka pokazala je nespecifičnu upalu, druga kazeoznu nekrozu bez pozitivnog bojenja prema Ziehl-Neelsenu, a treća granulomatoznu upalu visoko sumnjivu na sarkoidozu. Pacijent je tijekom hospitalizacije obavio cjelovit fizikalni pregled, te laboratorijsku i radiološku dijagnostiku. Fizikalni pregled prsnog koša pokazao je bilateralno prisutne grube krepitacije, a laboratorijski nalazi krvne slike normocitnu anemiju kronične bolesti. Na rendgenskoj snimci pluća uočeni su mali multipli čvorovi bilateralno, a nalaz direktnog sputuma bio je pozitivan. Zaključak: Iako je oralna tuberkuloza rijetko stanje, mora se uzeti u obzir u diferencijalnoj dijagnozi refraktornih bezbolnih oralnih ulkusa.
Introduction: The aim of this case report was to discuss an extremely rare oral lesion as a result of primary pulmonary tuberculosis. Case report: In this case report, the patient with refractory painless ulceration at ventral surface of the tongue was described. Detailed medical history was taken followed by clinical examination of the oral mucosa and palpation of regional lymph nodes. Clinical examination revealed ulceration on the patient’s ventro-lateral surface of the tongue, approximately two centimeters in diameter. Palpation of regional lymph nodes has not revealed enlargement. The toluidine blue test of the suspected lesion was performed at each control examination. Biopsy samples for histopathologic diagnosis were taken three times. The analysis of the first biopsy sample for histopathology revealed a non-specific inflammation, the second biopsy revealed a caseous necrosis without positive Ziehl-Neelsen staining and the third biopsy revealed a granulomatous inflammation which was highly suspicious of sarcoidosis. During hospitalization, the patient underwent a complete physical examination, and laboratory and radiological diagnostics. Physical chest examination revealed bilaterally coarse crepitations and laboratory findings of his complete blood count revealed normocytic anemia of chronic disease. Radiographic examination of lungs showed multiple small nodules bilaterally and positive direct sputum smear. Conclusion: Although oral tuberculosis is a rare condition, it must be taken into account in differential diagnosis of refractory painless oral ulcers.
Databáze: OpenAIRE
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