The Silent Threat: A Case Report of Occult Tuberculosis of the Buccal Mucosa, a Clinically Misleading Lesion Uncovered by Histopathology.

INTRODUCTION: The present case of oral tuberculosis represents an uncommon manifestation of Mycobacterium tuberculosis infection. Primary oral Tuberculosis is often easily overlooked during routine evaluation, because its clinical appearance overlaps with more frequently encountered reactive or benign lesions. CASE PRESENTATION: A seventy-two-year-old woman of poor socio-economic status presented with a small, firm swelling on the right buccal mucosa near tooth 18. Clinically, the lesion resembled a typical irritational fibroma. Histopathological examination revealed well-formed epithelioid granulomas with Langhans-type multinucleated giant cells. Ziehl-Neelsen staining demonstrated acid-fast bacilli within the lesion, supporting the diagnosis of tuberculous granuloma. Both Mantoux testing and chest radiography were unremarkable. The patient underwent standard antitubercular therapy and experienced complete resolution without recurrence at the six-month review. Persistent or atypical oral mucosal lesions should prompt consideration of Tuberculosis, especially in endemic regions. CONCLUSION: This case is unusual because the lesion clinically resembles a benign reactive growth in the absence of pulmonary involvement or systemic manifestations. The report highlights the diagnostic value of histopathological examination and emphasizes the importance of considering Tuberculosis in the differential diagnosis of persistent oral lesions. Early biopsy facilitates accurate diagnosis and appropriate therapy, minimizing morbidity.