Secondary lingual tuberculosis with extensive oropharyngeal involvement demonstrated by F18-FDG PET/CT: a rare case report

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Here, we present the case of a 42-year-old woman who presented with a clinical picture of odynophagia, hoarseness, cough, night sweats, and marked weight loss. Fluorodeoxyglucose positron emission tomography and computed tomography demonstrated heterogeneous hypermetabolic activity involving the oropharynx, nasopharynx and hypopharynx up to supraglottic larynx. Other findings were pulmonary miliary nodules with hypermetabolism, and mesenteric lymphadenopathy. Histopathology of a base-of-tongue biopsy revealed necrotizing granulomatous inflammation; however, Ziehl–Neelsen staining, mycobacterial culture, and polymerase chain reaction of the biopsy specimen, as well as sputum acid-fast bacilli examination, were all negative. In the absence of microbiological confirmation, a diagnosis of presumptive secondary lingual tuberculosis was established based on the combination of compatible clinical, radiological, and histopathological findings, after exclusion of alternative etiologies. The patient was empirically treated with a standard six-month four-drug anti-tuberculosis regimen, with rapid symptom improvement and complete recovery, remaining recurrence-free at the three-year follow-up. Our findings emphasize that tuberculosis should remain part of the differential diagnosis for persistent oral and oropharyngeal ulcerative lesions, especially when systemic findings coexist, even in the absence of microbiological confirmation. Fluorodeoxyglucose positron emission tomography and computed tomography can play a pivotal role in detecting disseminated disease and guiding targeted biopsies. Early diagnosis and prompt empirical therapy can lead to favorable long-term outcomes. Not applicable.

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