NEW MICROBIOLOGICA, 35, 233-237, 2012 Lingual tuberculosis: a rare disease in Western countries Maria Bruna Pasticci 1 , Piero Floridi 2 , Elisabetta Schiaroli 1 , Gian Maria Stagni 1 , Giuseppe Vittorio De Socio 1 , Fabrizio Longari 3 , Franco Baldelli 1 1 Infectious Disease Section, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Perugia, Italy; 2 Department of Neuroradiology, Hospital Santa Maria della Misericordia, Perugia, Italy; 3 Department of Otolaryngology, Head and Neck Surgery, University of Perugia, Perugia, Italy INTRODUCTION Lingual tuberculosis (TB) is rare and accounts for 0.5-3% of all cases of extrapulmonary TB. It is more frequently diagnosed in immunocom- promised patients, males and smokers. It is com- monly secondary to contact with infected respi- ratory secretions or hematogenous dissemination of Mycobacterium tuberculosis (Kakisi et al., 2010; Gupta et al., 2011; Mignogna et al., 2000; Gharebaghi et al., 2011). Rarely is it due to direct inoculation. Primary oral tuberculosis is more common in younger patients (Kakisi et al., 2010; Kumar S et al., 2010; Sharma et al., 2008). TB le- sions of the oral cavity are infrequent in Western countries (Kakisi et al., 2010; Gupta et al., 2011; Corresponding author Prof. Maria Bruna Pasticci Infectious Disease Section Department of Experimental Medicine and Biochemical Sciences University of Perugia P.zza Università, 1 - 06100 Perugia E-mail: pasticci@unipg.it Mignogna et al., 2000; Gharebaghi et al., 2011). Diagnosis requires searching for M.tuberculosis in lingual biopsy or searching for other sites of tuberculosis (Kakisi et al., 2010; Sharma et al., 2008; Mignogna et al., 2000; Gharebaghi et al., 2011). This paper reports on two consecutive cases of lingual tuberculosis progressing to disseminated disease involving the lungs, lymph nodes and the brain. CASE REPORT 1 A 57-year-old immunocompetent male smoker from Moldova who had been living in Italy for the last six years underwent a biopsy for an ul- cer in the left posterior part of his tongue in February 2005. The patient did not report a his- tory of tuberculosis. Histopathology disclosed necrosis and chronic granulomatous reaction with giant cells. Healing was obtained after a two week course of moxifloxacin. Over the following months, the patient relapsed twice: both episodes Here we report on two consecutive cases of tuberculosis in immunocompetent HIV-negative patients with lingual le- sions. In both patients diagnosis was delayed. Disease progressed involving the lungs, lymph nodes and also the brain. Both patients are disease-free at 30 and 22 month follow-up respectively. Isolated Mycobacterium tuberculosis from these patients was multi-susceptible. Tuberculosis lesions of the oral cavity and brain are infrequently diagnosed in immunocompetent subjects from Western countries. Clinicians must take into greater consideration tuberculosis as a possible diagnosis when diagnosing chronic and/or recurrent lingual lesions even in the absence of pulmonary le- sions. KEY WORDS: Tongue tuberculosis, Tongue ulceration, Brain tuberculomas, Brain mass lesions, Anti-tuberculosis therapy, Immunocompetent patients SUMMARY Received July 26, 2011 Accepted October 13, 2011