Report of a Case of Tuberculosis of Mandibular Condyle in a Patient on Haemodialysis
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CASE REPORT
Report of a Case of Tuberculosis of Mandibular Condyle in a Patient on Haemodialysis Shreya Krishna1 • Aditya Moorthy1 Prashanth Bhat1 • Shobha Hegde1
•
Prithvi Bachalli1
•
Rohith Gaikwad2
•
Received: 3 April 2019 / Accepted: 7 June 2019 Ó The Association of Oral and Maxillofacial Surgeons of India 2019
Introduction
Case Report
Tuberculosis is an infectious disease of granulomatous nature affecting multiple organs commonly caused by the acid-fast bacilli Mycobacterium tuberculosis and rarely Mycobacterium bovis [1]. Worldwide, tuberculosis is one of the top ten causes of death and the leading cause from a single infectious agent (above HIV/AIDS). India has the highest tuberculosis burden in the world accounting for 27% of all the cases in the world [2]. Head and neck tuberculosis comprises nearly 10% of all cases of extrapulmonary tuberculosis (EPTB) [3]. Primary TB of the temporomandibular joint (TMJ) is a rare occurrence, and only 14 such cases have been reported in the literature so far. The presentation of tuberculous infection of the TMJ can resemble arthritis, osteomyelitis or any other kind of chronic joint disease. Many risk factors are associated with tuberculosis, such as human immunodeficiency virus (HIV) infections, transplant recipients, substance abuse, renal insufficiency, malignancy and low socio-economic status [4]. Because of cellular immunity defects, patients with end-stage renal disease (ESRD) are at increased risk of developing TB [5]. Primary tuberculosis of the condyle occurring in patient of chronic kidney disease undergoing haemodialysis is being reported here for the first time in English literature.
A 61-year-old female patient presented to the OPD with a history of preauricular swelling present since a month. She was treated by otolaryngologists for a presumptive diagnosis of acute parotitis with antibiotics which brought no relief. The patient was being haemodialysed biweekly for chronic renal failure. Examination revealed a diffuse, tender swelling measuring approximately 3 cm 9 4 cm in the right preauricular region (Fig. 1). No abnormality was noted in the overlying skin or intra-orally. Mouth opening at that time was 15 mm. A panoramic radiograph revealed an osteolytic lesion of the right condyle, and CT scan confirmed the provisional diagnosis of osteomyelitis (Fig. 2). She was seronegative for human immunodeficiency virus. Given the medical status of the patient, condylectomy with debridement was planned. As the capsule of the TMJ was incised, a copious amount of pus exuded (approx. 20 ml) which was collected for culture and sensitivity tests as well as for acid-fast bacilli. Sequestrae with respect to mandibular condyle and a portion of superior aspect of ramus were teased out, debrided and sent along with the condylar specimen for histopathologic testing (Fig. 3). The histopathology studies reported caseating, granulomatous lesion of the right mandibular condyle (Fig. 4). This indicated a tuberculous infection of the TMJ. Pulmonary involvement was ruled ou
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