舌結核潰瘍－病例報告及聚合酶鏈鎖反應(PCR)偵測之應用

Tuberculous Ulcer of the Tongue: A Case Report and the Application of PCR Detection

吳建宗(Chien-Tzung Wu) ； 季曉敏(Shiao-Ming Ghi) ； 吳上賓(Shang-Pin Wu) ； 石濟民(Ghi-Min Shih) ； 張龍昌(Lung-Chang Chang)

《中華民國口腔顎面外科學會雜誌》 8卷2期 (1997/09) Pp. 94-102

https://doi.org/10.7104/CJOMS.199709.0094

摘要

舌結核潰瘍在臨床上極為罕見，因此牙醫師在作例行之口腔檢查時常會將其忽略。舌結核通常伴隨著其它結核病如口咽、肺、淋巴結或粟狀結核。無結核病發生於身體何處，應對其儘早診斷並作治療，也正是提出此一罕見病例之用意。一位34歲男性原住民，因左側舌緣一劇痛之潰瘍致吞嚥發音困難來院求診，全身檢查除舌部病灶外並無特別發現，初步臆測為口腔癌，然門診切片檢查結果懷疑為舌結核潰瘍，病患在此之前未曾被診斷患有結核病。經病理科醫師建議以分子生物學之聚合酶鏈鎖反應(Polymerase Chain Reaction, PCR)偵測來輔助診斷，最後得以確認為舌結核潰瘍，經抗結核藥物治療，病灶逐漸縮小，癥狀緩解。

關鍵字

舌結核潰瘍 ； 口腔結核 ； 結核桿菌 ； 聚合酶鏈鎖反應

並列摘要

Tuberculous ulcer of the tongue is still a rare condition in clinic, which is likely to be missed on oral routine examination. In general, tuberculosis of the tongue is usually accompanied with other tuberculosis, such as oropharynx, lungs, lymph nodes, or miliary tuberculosis. The purpose of this report is that tuberculosis should be discoveried and treated as early as possible because it can affect any part of the body; the oral cavity is no exception. A 34-year-old aboriginal male suffered from great difficulty in eating and talking and demanded our OPD for help owing to a persistently severe painful ulcer on the left side of the tongue. With the exception of the tongue ulcer, no particular finding was noted on physical examination. A provisional diagnosis of malignant ulcer of the gongue was made. On the other hand, the incisional biopsy strongly suggested that it is a tuberculous ulcer. He did not give a history of any major illness and pulmonary tuberculosis in the past. The polymerase chain reaction (PCR) method was suggested by the pathologist for detection of the Mycobacterium tuberculosis. Finally, a diagonsis of tuberculous ulcer of the tongue was confirmed. The patient was put on a regimen of antituberculosis drugs. When he returned after 2 weeks, the lesion on the tongue had regressed considerably and symptoms relieved.