Tuberculosis of the temporomandibular joint: a rare case report and review of the literature

Abstract

Head and neck tuberculosis represents a rare form of extrapulmonary tuberculosis and usually concerns the cervical lymph nodes. Involvement of the temporomandibular joint (TMJ) is extremely rare and only reported at a level of case report forms. A 20-year-old female patient of African origin presented with pain in the mandible and swelling at the left masticator since one month ago. Head and brain CT scan revealed multiple hyperdense lesions with peripheral enhancement and surrounding swelling. These findings were consistent with multiple abscesses. Moreover, severe impairment and the presence of fluid was observed at the left temporomandibular joint, the mandible and the left masseter muscle. Chest CT scan revealed centrilobular nodules in both upper lung lobes. Treatment with common antibiotics was initiated but the patient did not improve. During hospitalization, the patient experienced an episode of generalized tonic-clonic convulsion. Therefore, a surgical drainage of the mandibular abscess was performed. The AFB smear and the molecular test (XPERT MTB/RIF) were positive for Mycobacterium tuberculosis sensitive to rifampicin. The patient was treated with isoniazid, high dose rifampicin (900 mg), pyrazinamide, ethambutol and moxifloxacin. The patient received treatment for 12 months and improved significantly clinically and radiologically. Diagnosis of tuberculosis in the temporomandibular joint is challenging but should be included in the differential diagnosis when a compatible history of exposure and other organ involvement exist.