1093 Mandibular Swelling as the First Sign: A Rare Case of Tuberculous Osteomyelitis

Abstract Tuberculous (TB) osteomyelitis of the mandible is exceedingly rare, constituting less than 2% of all skeletal tuberculosis cases. This case report describes the initial presentation of a patient with tuberculosis manifesting as swelling associated with the mandible, highlighting the importance of considering TB in the differential diagnosis of jaw swelling, especially in individuals from endemic regions. A 53-year-old male from Congo, presented with a one-month history of right-sided facial swelling, restricted mouth opening, and earache. Initial investigations, including an orthopantomogram (OPG), revealed a unilocular radiolucent lesion at the right mandibular angle, with no obvious dental pathology. A computed tomography (CT) scan showed a multi-loculated, necrotic, thick-walled collection around the right mandibular ramus, with bony destruction. Due to the degree of bone destruction, his case was discussed in the Head and Neck MDT, as osteosarcoma was suspected. Initial ultrasound-guided core biopsy was inconclusive. Repeat fine needle aspiration (FNA) aspirated pus, and cytology showed granulomas, suggesting tuberculosis. Further diagnostic testing confirmed Mycobacterium tuberculosis on a lower respiratory tract swab and FNA PCR. The patient was started on anti-TB therapy and underwent two incision and drainage (I&D) procedures for abscesses in the right buccal, deep neck, and parapharyngeal spaces. He was discharged on anti-TB medication and followed up by the respiratory team. This case underscores the importance of maintaining a high index of suspicion for TB in patients from endemic regions and highlights the need for early diagnosis and multidisciplinary management.