Fig. 5
From: Difficult and complicated oral ulceration: an expert consensus guideline for diagnosis
A 72-year-old man with palatal ulceration for 3 months. Widespread ulcers and masses on the palate and maxillary palatal gingiva, extending to the posterior part of the soft palate. He denied the history of systemic diseases. HE staining of repeated oral biopsies showed infiltration of neutrophils and chronic inflammation. Further detailed history inquiry revealed that he developed tuberculosis over a decade ago and was cured after the treatment. We suggested him to take specimen to the superior pathologists for consultation. Granulomatous inflammation containing Langhans-type giant cells was identified, raising the possibility of granulomatous infection. Ziehl-Nielsen staining showed acid-fast bacilli. A chest x-ray revealed bilateral upper lobe consolidation and cavitation, consistent with pulmonary tuberculosis. The definitive diagnosis of oral tuberculosis was established. The ulcers healed, and masses gradually resolved after a combination of isoniazid, rifampicin, pyrazinamide, and ethylaminobutanol for 1 month
