Pulmonary tuberculosis with oral involvement presenting as persistent non-healing post-extraction lesions: a case report

Tuberculosis (TB) of the oral cavity is uncommon and often presents with nonspecific clinical features, which may delay diagnosis. Oral lesions may mimic malignancy, chronic inflammatory conditions, or non-healing extraction wounds, making histopathologic evaluation essential in persistent cases. We report a case of oral TB presenting as persistent non-healing post-extraction lesions in a 74-year-old male. The patient presented with pain, gingival swelling, and pus discharge after extraction of multiple mandibular teeth. Intraoral examination revealed multifocal ulcerative lesions involving the left mandibular posterior gingiva and right palatal mucosa. Histopathologic examination demonstrated chronic granulomatous inflammation with acid-fast bacilli positivity, and real-time polymerase chain reaction performed on the oral tissue specimen detected Mycobacterium tuberculosis. The Xpert MTB/RIF assay performed on a sputum specimen also detected M. tuberculosis. Subsequent pulmonary evaluation confirmed active pulmonary TB, and the patient was clinically diagnosed with pulmonary TB with oral involvement. Anti-TB therapy was initiated, and the oral lesions gradually resolved during follow-up, with no recurrence observed during approximately 1 year of follow-up. This case highlights that persistent post-extraction oral lesions unresponsive to conventional treatment should prompt timely biopsy to establish a definitive diagnosis, while concomitant respiratory or constitutional symptoms should also warrant appropriate pulmonary evaluation.