A Mysterious Case of Primary Oral Tuberculosis in a 14-Year-Old Indian Female: A Diagnostic Enigma in a Case Report

Tuberculosis (TB), caused by <i>Mycobacterium tuberculosis</i>, is a chronic infectious disease that primarily affects the lungs but can involve other parts of the body, including the oral cavity, which leads to diagnostic challenges. This case report describes a 14-year-old female patient who presented with persistent swelling, pus discharge, and pain on the left side of the mandible for six months. Initial treatment, including incision and drainage, failed to resolve the symptoms. Imaging and histopathological examination revealed tuberculous osteomyelitis of the mandible. Despite negative microbiological results, the diagnosis was confirmed through the presence of granulomatous inflammation with giant cells on biopsy. The patient was subsequently referred for anti-TB treatment and showed significant improvement during follow-up. Oral TB, although rare, should be considered in the differential diagnosis of chronic oral lesions, especially when standard treatments fail. This case emphasizes the importance of comprehensive diagnostic approaches, including imaging and histopathology, which ultimately help initiate the correct treatment as early as possible.