Palatal Tuberculosis: A Rare Manifestation of Extrapulmonary Tuberculosis

Tuberculosis (TB) remains a relevant public health concern in Portugal, despite the progress achieved in its control and management over recent years. Extrapulmonary manifestations represent a notable proportion of cases, while oral manifestations are uncommon, particularly those affecting the palate, which are rarely reported. The authors describe a case of a 63-year-old Afghan woman with multiple comorbidities, including poorly controlled diabetes mellitus with end-organ damage and heart failure, who presented with a painless ulcerated lesion on the hard palate with erythematous borders and fibrin coverage. Laboratory evaluation revealed a positive interferon-gamma release assay, and a computed tomography showed oropharyngeal tissue densification and calcified pulmonary micronodules. Despite bacilloscopy being negative, sputum culture was positive for Mycobacterium tuberculosis complex. Biopsy revealed non-necrotizing granulomatous inflammation, confirming the diagnosis of palatal TB. Standard anti-TB therapy with rifampicin, isoniazid, pyrazinamide, and ethambutol was initiated, resulting in near-complete resolution of the lesion after 30 days. Unfortunately, treatment was discontinued following ischemic hepatitis and myocardial infarction, and the patient subsequently died of septic shock due to a multidrug-resistant nosocomial infection. Palatal TB is a rare condition that can mimic other oral diseases, raising major diagnostic challenges, especially in immunocompromised patients. It should be considered in persistent oral ulcers, and early diagnosis and treatment are crucial for better outcomes.