A Rare Case of Orofacial Tuberculosis Mimicking a Buccal Abscess

Tuberculosis (TB) remains a leading cause of infectious disease mortality worldwide, with extrapulmonary manifestations often presenting diagnostic challenges. Orofacial TB, though rare, can mimic other inflammatory or neoplastic conditions due to its non-specific clinical features. We report a case of a 44-year-old female presenting with a persistent, non-tender swelling in the left buccal mucosa. Radiographic imaging suggested a fistulous tract and associated intraosseous changes. Initial antibiotic therapy and extraction of suspect teeth failed to resolve the lesion. Histopathological examination following incisional biopsy revealed granulomatous inflammation with caseating necrosis and Langhans-type giant cells, confirming TB. After ruling out systemic TB, a diagnosis of orofacial TB was made. The patient responded favorably to a six-month anti-tubercular therapy regimen, with complete resolution of symptoms. This case highlights the importance of maintaining a high index of suspicion for TB in persistent orofacial lesions, particularly in endemic areas. A multidisciplinary diagnostic approach is essential for timely and accurate identification to ensure effective treatment outcomes.