Tuberculosis of the tongue treated with streptomycin and PAS.

Tuberculosis of the tongue may well be considered a rarity since less than 500 cases have been reported. Statistics vary considerably as to its incidence, but it is probable that the complication would be less rare were more attention given to the tongue upon examination of the patient and at the autopsy table. It is generally agreed that the lingual form of tuberculosis is found less frequently in the colored than in the white race. Indeed, some authors’2 state that no case has been described in the negro. The lesion, however, occurs more frequently in the male than in the female and no age is exempt, as a case has been described in a child five and one-half years of age and in a man of 80 years, where the tongue had been amputated following the erroneous diagnosis of carcinoma.3 The onset of the lesion is insidious. The patient may complain of difficulty in articulation and in swallowing, and examination reveals some enlargement and thickening of the tongue. Later a focal point may be localized and softening takes place to be succeeded by ulceration. Little, if any pain is felt prior to ulceration, after which, as a rule, excruciating pain is generally continuously present. Tuberculosis of the tongue must be differentiated from toxic glossitis, syphilis, carcinoma and other neoplasms. While epthous ulcers usually yield to rather simple remedies, the differentiation of tuberculosis and syphilis may be difficult as the patient may have both a tuberculin and a blood reaction. A thorough physical examination, moentgenograms of the chest and intensive sputum studies should be done for obvious reasons. Since cervical adenopathy may occur in both conditions, little reliance may be placed upon enlargement of the nodes. Biopsy examination, while often informative, is not always conclusive, as the microscopic differentiation is sometimes not possible. As a rule tubercle bacilli are not easily demonstrable by histological study of biopsy material. Before the use of streptomycmn, para-ammnosalicylic acid, etc., the prognosis was poor, and not enough cases treated with these drugs have been reported to warrant any definite conclusion as to their value. Judging by analogy, however, we feel justified In anticipating much. Although the comparative rarety of muscular tissue to infection by the tubemcle bacillus, the movements of the tongue and the bactericidal action of the sputum have all, singly or in combination, been cited to account for the rarity of the lingual tuberculosis, nothing has been proved. Infec-