Extrapulmonary Tuberculosis of Lower Gingiva-A Case Report

下顎牙齦結核－病例報告

朱健豪(Jain-Hao Jhu) ； 顏欽堉(Ching-Yu Yen) ； 劉宜華(I-Hua Liu)

《臺灣口腔顎面外科學會雜誌》 30卷1期 (2019/03) Pp. 16-25

摘要

Extrapulmonary tuberculosis (TB) is rare, especially that involves oral cavity. The most common site of oral TB is tongue, while gingival TB is less common. The clinical manifestations of oral TB include ulceration, swelling and discharge with or without pulmonary signs and symptoms. Immunosuppression therapy could increase the virulence of pathogens. Poor oral hygiene, trauma, chronic inflammations are the local predisposed factors. The presenting case is a gingival TB patient without pulmonary symptom, who visited our department due to chronic gingival pain. The lesion was excised and the postoperative histopathological examination revealed a gingiva TB. Subsequent sputum culture confirmed the diagnosis of lung TB, therefore a nine months multiple anti-TB drugs therapy was conducted. The patient recovered well after the course finished. A comprehensive investigation includes laboratory test, chest radiography and histopathological examinations should be carried out while oral TB is suspected. Early diagnosis and proper managements are the key to prevent and control both oral and pulmonary TB.

關鍵字

Extrapulmonary tuberculosis ； Gingiva ； Oral tuberculosis

並列摘要

肺外結核，尤其是口腔結核爲一種罕見的疾病。最常見的口腔結核好發於舌頭，牙齦結核則較爲少見。口腔結核的常見表徵有潰瘍、腫脹及滲出液，同時合併有無肺部症狀。系統性因子包含免疫抑制與較強的致病菌術。局部因子則包含不良的口腔清潔、局部創傷、慢性發炎及牙齒的萌發。我們提出此一無肺部症狀之口腔結核病例，初始因慢性牙齦疼痛就診。藉由切除性病理玻片及結核菌痰液培養後確診後，病人接受爲期九個月之多抗結核藥物治療且復原並良好。當臨床遭遇持續對常規治療無反應之口内病灶區，即便無肺部知症狀，口腔結核仍應作爲鑑別診斷。完整的實驗室評估、免疫缺乏測試、胸腔X光及組織病理檢查以便及早診斷與開始適當的治療。

並列關鍵字

肺外結核 ； 牙齦 ； 口腔結核