Disseminated primary multidrug resistant tuberculosis with concurrent pleural and oral cavity involvement: the first reported case

Tuberculosis (TB) remains one of the most significant infectious diseases worldwide, with multidrug resistant TB (MDR-TB) posing a major therapeutic challenge. Pleural TB is a common extrapulmonary manifestation; however, concurrent oral cavity involvement is extremely rare. We report the case of a 42-year-old male who presented with chronic cough, low-grade fever, dysphagia, and significant weight loss for three months. Clinical and radiological evaluation revealed left-sided pleural effusion and an ulcero-proliferative lesion involving the base of the tongue and left pyriform fossa. Histopathological examination of pleural and tongue biopsies showed granulomatous inflammation with acid-fast bacilli, while cartridge-based nucleic acid amplification testing (CBNAAT) confirmed Mycobacterium tuberculosis with rifampicin resistance. A diagnosis of disseminated primary MDR-TB involving both the pleura and oropharyngeal cavity was established. The patient was treated with an all-oral longer MDR-TB regimen, resulting in significant clinical improvement. This case highlights the importance of using molecular diagnostic tests early to detect drug resistance in unusual forms of extrapulmonary tuberculosis and reminds clinicians to consider tuberculosis as a possible cause of ulcerative oropharyngeal lesions that resemble malignancy, particularly in TB-endemic regions like India.