Accepted Manuscript Title: Lingual tuberculosis in an HIV/AIDS Patient Authors: Jos´e Y Rodr´ıguez, Gerson J Rodr´ıguez, Carlos A ´ Alvarez-Moreno PII: DOI: Reference: S1201-9712(17)30086-3 http://dx.doi.org/doi:10.1016/j.ijid.2017.03.003 IJID 2892 To appear in: International Journal of Infectious Diseases Received date: Revised date: Accepted date: 3-1-2017 24-2-2017 1-3-2017 ´ Please cite this article as: Rodr´ıguez Jos´e Y, Rodr´ıguez Gerson J, Alvarez-Moreno Carlos A.Lingual tuberculosis in an HIV/AIDS Patient.International Journal of Infectious Diseases http://dx.doi.org/10.1016/j.ijid.2017.03.003 This is a PDF file of an unedited manuscript that has been accepted for publication As a service to our customers we are providing this early version of the manuscript The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain Lingual tuberculosis in an HIV/AIDS Patient Article's reference number IJID 2892 List of Authors and affiliations José Y Rodríguez MD Gerson J Rodríguez MD Carlos A Álvarez-Moreno MD Centro de Investigaciones Microbiológicas del Cesar (CIMCE) Hospital Rosario Pumarejo de López Clínica Laura Daniela and Clínica Médicos LTDA Valledupar, Colombia Universidad Nacional de Colombia, Facultad de Medicina and Clínica Universitaria Colombia, Colsanitas Bogotá, Colombia Keywords: oral ulcers, tongue tuberculosis, lingual tuberculosis, Oral tuberculosis, HIV Infections, Mycobacterium tuberculosis Highlights Oral Tb should be included in the differential diagnosis of oral lesions, irrespective of the existence of pulmonary signs and symptoms The diagnosis of oral Tb is difficult and can be performed by pathological examination and PCR assays A 45-year-old man presented with a months’ history of a painless persistent ulcer in the tip of the tongue, with slightly elevated margin The lesion worsens to compromise the distal third of the tongue (A) The patient did not smoke or drink alcohol and he has a history of HIV infection, non-adherent to antiretroviral therapy (viral load of HIV1 RNA 31189 copies and CD4+ T cell count of 200 cells/mm3) Incisional biopsy of the indurated upper border in apex showed central necrotic tissue and chronically inflamed granulation with epithelioid cells (B) Acid fast bacilli weren’t identified in Ziehl-Neelsen staining IS6110 real-time PCR for detection of Mycobacterium tuberculosis complex in DNA extracted from formalin-fixed paraffin embedded was positive Anti-TB drug regimen of isoniazid, rifampicin, pyrazinamide, and ethambutol was prescribed with adequate clinical response (C) Oral tuberculosis is a rare entity accounts for 0.1-1.5% of extrapulmonary TB cases (1) May be primary, which are rare and occur as a result of the direct inoculation of oral tissues, or secondary, due to hematogenous or lymphatic dissemination and extensions of nearby structures In this case we consider that it is a post-primary Tb since it is the most common presentation (2) They present as ulcers, nodules, tuberculomas, fissures o periapical granulomas May occur at any location on the oral mucosa, but the tongue is most commonly affected (2) The differential diagnosis includes traumatic or aphthous ulcers, actinomycosis, syphilitic ulcer, mycotic infections, Wegener's granuloma, sarcoidosis, Crohn's disease and malignancy (3) Nemes RM, Ianosi ES, Pop CS, Postolache P, Streba CT, Olteanu M, et al Tuberculosis of the oral cavity Rom J Morphol Embryol 2015;56(2):521-5 Kakisi OK, Kechagia AS, Kakisis IK, Rafailidis PI, Falagas ME Tuberculosis of the oral cavity: a systematic review Eur J Oral Sci 2010 Apr;118(2):103-9 Gharebaghi N, Monsouri SA, Darazam IA, Mansouri D, Sajadi MM, Mansouri N A 40-year-old man with tongue lesions Lingual and pulmonary tuberculosis (TB) Clin Infect Dis 2011 May;52(10):1231, 1276-7 Ethics statement: Written informed consent was obtained from the patient for the publication of this case report Conflict of interest: None of the authors report a conflict of interest, and there were no funding sources All of the authors have submitted the ICMJE Form for the Disclosure of Potential Conflicts of Interest Figure 1: A: Photograph of the patient's tongue showing ulcer in the tip of the tongue B: Hematoxylin eosin staining C: Clinical response months after treatment