Chief complaint of a pain...

A 57-year-old male patient with H/o TB 40 years back visited the Dental Hospital with a chief complaint of a painful ulcer on the tip of the tongue. The ulcer had developed 3–4 weeks ago without any apparent initiating event such as trauma. He described a pricking sensation and soreness upon touching. Intraoral examination revealed around 0.7 cm in diameter ulcer on the tip of the tongue. 

There was no indication of lymph node association or bone involvement. The laboratory blood examinations showed average values, and serological tests showed negative for HIV, Hepatitis. There was a subtle improvement after conservative management, but the ulcer did not wholly disappear. Biopsy results eventually rule out malignancy. Histological examination of the ulcer revealed the presence of numerous granulomatous inflammations, epithelioid cells and multiple Langhans giant cells with aggregate spots of infectious species as shown in the figure.