PMC7554358_01
Ulcer on the dorsum of the tongue.
gr1.jpg
PMC7554358_01_gr1.jpg
fig0005
The patient was evaluated by Otorhinolaryngology, who described a papillomatous, hardened and painful lesion measuring about three centimeters in the posterior third of the tongue, accompanied by bilateral cervical lymphadenopathies, with a tentative diagnosis of squamous cell carcinoma (Fig. 1).
Numerous epithelioid granulomas that infiltrate the mucous and muscular tissue, along with giant multinucleated cells. Some of the granulomas have central necrosis (*), (hematoxylin-eosin, 40x).
gr2.jpg
PMC7554358_01_gr2.jpg
fig0010
The anatomical pathology studied excluded a neoplastic lesion, instead, it showed infiltration by numerous epithelioid granulomas, some with central necrosis and frequently accompanied by giant multinucleated cells of the Langhans type (Fig. 2).
Acid-fast bacilli as seen with the Ziehl-Neelsen staining (1000x).
gr3.jpg
PMC7554358_01_gr3.jpg
fig0015
Ziehl-Neelsen staining revealed the presence of occasional acid-fast bacillary structures (Fig. 3).
Thorax computerized tomography demonstrating bilateral tree-in-bud pattern and cavitation in the left lung.
gr4.jpg
PMC7554358_01_gr4.jpg
fig0020
The chest CT showed a tree-in-bud pattern and cavitations (Fig. 4.).
Dorsum of the tongue, at the end of treatment.
gr5.jpg
PMC7554358_01_gr5.jpg
fig0025
The patient completed nine months of treatment (isoniazid, rifampin, pyrazinamide, and ethambutol regimen), with total resolution of the tongue lesion (Fig. 5.) and weight recovery.