Primary tuberculous osteomyelitis of the maxilla mimicking a refractory post-endodontic infection: A diagnostic challenge.

Primary extrapulmonary tuberculosis involving the maxillofacial region is rare and often poses a diagnostic challenge because of its atypical presentation and the absence of pulmonary involvement. We report a case of a 38-year-old woman who developed rapidly progressive osteomyelitis of the maxilla following elective root canal treatment. The lesion was unresponsive to empirical antibiotic therapy and standard dental intervention. Cone-beam computed tomography revealed extensive osteolytic destruction, and histopathological examination demonstrated granulomatous inflammation with Langhans giant cells. Systemic evaluation showed no evidence of pulmonary tuberculosis, with negative chest radiography, acid-fast bacillus smear of sputum, and Mantoux test results. Cartridge-based nucleic acid amplification testing (CBNAAT) of the curetted bone tissue detected Mycobacterium tuberculosis without rifampicin resistance, confirming the diagnosis. The patient responded favorably to surgical debridement, followed by standard anti-tubercular therapy. This case highlights the importance of considering primary tuberculous osteomyelitis in persistent, non-healing maxillary lesions, even in the absence of pulmonary disease, and underscores the value of combining clinicoradiological, histopathological, and molecular investigations for a timely diagnosis.