{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T13:39:23Z","timestamp":1792157963047,"version":"4.4.0"},"reference-count":21,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2016,9,7]]},"abstract":"<jats:p>A 3-year-old girl child presented with swelling in her right lower jaw that had started 5 days previously. History revealed the child being non-immunised. Initial-evaluation revealed proptosis and bony hard swelling over the right body of the mandible. Radiological evaluation including a CT scan indicated expansile osteolytic lesion involving the body-ramus with onion-peel periosteal reaction suggesting osteomyelitis\/malignancy. Blood investigations showed raised erythrocyte sedimentation rate and eosinophilia. Family screening for tuberculosis (TB) revealed that the patient, her father and siblings were PPD positive though chest screening and sputum examinations were negative in all of them. Lesion biopsy showed acute\/chronic osteomyelitis with eosinophilia, tilting diagnosis towards eosinophilic granuloma\/Hand\u2013Schuller\u2013Christian disease. Further investigations for diabetes insipidus, histiocytosis-X, skull\u2013pelvic\u2013femur radiographs, abdominal ultrasonography, ophthalmic consultation and PCR-TB test were negative. Histology, radiography, purified protein derivative (PPD)-positive result and history led to the diagnosis of primary TB of the mandible. Complete resolution occurred following antitubercular therapy. The case report emphasises that diagnosis of TB can sometimes be based on circumstantial evidence and positive response to antitubercular therapy even in view of a negative PCR result.<\/jats:p>","DOI":"10.1136\/bcr-2016-216854","type":"journal-article","created":{"date-parts":[[2016,9,21]],"date-time":"2016-09-21T09:58:12Z","timestamp":1474451892000},"page":"bcr2016216854","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Primary tuberculous osteomyelitis of the mandible in a 3-year-old child"],"prefix":"10.1136","volume":"2016","author":[{"given":"Shruti S","family":"Sambyal","sequence":"first","affiliation":[{"name":"Department of Oral Medicine, Himachal Pradesh Government Dental College and Hospital, Shimla, Himachal Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajit D","family":"Dinkar","sequence":"additional","affiliation":[{"name":"Department of Oral Medicine, Goa Dental College and Hospital, Bambolim, Goa, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1550-7077","authenticated-orcid":false,"given":"Cheranjeevi","family":"Jayam","sequence":"additional","affiliation":[{"name":"Department of Pedodontics and Preventive Dentistry, Himachal Pradesh Government Dental College and Hospital, Shimla, Himachal Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhanu Pratap","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Conservative Dentistry and Endodontics, Himachal Pradesh Government Dental College and Hospital, Shimla, Himachal Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2016,9,21]]},"reference":[{"key":"2025082802003799000_2016.sep21_1.bcr2016216854.1","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1017\/S0022215107006913","article-title":"Tuberculosis in the head and neck: experience in India","volume":"121","author":"Prasad","year":"2007","journal-title":"J Laryngol Otol"},{"key":"2025082802003799000_2016.sep21_1.bcr2016216854.2","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1007\/BF02907752","article-title":"Primary lingual tuberculosis presenting as cold abscess Tongue: a case report","volume":"58","author":"Vishwakarma","year":"2006","journal-title":"Indian J Otolaryngol Head Neck Surg"},{"key":"2025082802003799000_2016.sep21_1.bcr2016216854.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0278-2391(89)80019-9"},{"key":"2025082802003799000_2016.sep21_1.bcr2016216854.4","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1046\/j.1365-263X.2001.00276.x","article-title":"Tuberculous osteomyelitis of the mandible: a case report","volume":"11","author":"Bhatt","year":"2001","journal-title":"Int J Paediatr Dent"},{"key":"2025082802003799000_2016.sep21_1.bcr2016216854.5","first-page":"317","article-title":"Tuberculous osteomyelitis in the mandible of a child","volume":"9","author":"Wood","year":"1987","journal-title":"Pediatr Dent"},{"key":"2025082802003799000_2016.sep21_1.bcr2016216854.6","first-page":"147","article-title":"Tubercular osteomyelitis of mandible","volume":"52","author":"Gupta","year":"2005","journal-title":"Indian J Tuberc"},{"key":"2025082802003799000_2016.sep21_1.bcr2016216854.7","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.15.0221"},{"key":"2025082802003799000_2016.sep21_1.bcr2016216854.8","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(15)00091-1"},{"key":"2025082802003799000_2016.sep21_1.bcr2016216854.9","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(15)00200-3"},{"key":"2025082802003799000_2016.sep21_1.bcr2016216854.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.tripleo.2003.10.032"},{"key":"2025082802003799000_2016.sep21_1.bcr2016216854.11","doi-asserted-by":"publisher","DOI":"10.1016\/0030-4220(84)90262-7"},{"key":"2025082802003799000_2016.sep21_1.bcr2016216854.12","doi-asserted-by":"publisher","DOI":"10.1016\/0030-4220(92)90120-F"},{"key":"2025082802003799000_2016.sep21_1.bcr2016216854.13","doi-asserted-by":"publisher","DOI":"10.4103\/0970-9290.29893"},{"key":"2025082802003799000_2016.sep21_1.bcr2016216854.14","doi-asserted-by":"publisher","DOI":"10.1016\/S0278-2391(98)90623-1"},{"key":"2025082802003799000_2016.sep21_1.bcr2016216854.15","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1590\/S1413-86702003000100009","article-title":"Clinical and radiological analysis of children and adolescents with tuberculosis in Bahia, Brazil","volume":"7","author":"Franco","year":"2003","journal-title":"Braz J Infect Dis"},{"key":"2025082802003799000_2016.sep21_1.bcr2016216854.16","doi-asserted-by":"publisher","DOI":"10.1016\/0030-4220(91)90017-7"},{"key":"2025082802003799000_2016.sep21_1.bcr2016216854.17","first-page":"131","article-title":"Role of fine needle aspiration cytology of lymph nodes in the Diagnosis of cutaneous tuberculosis","volume":"51","author":"Lanka","year":"2004","journal-title":"Indian J Tuberc"},{"key":"2025082802003799000_2016.sep21_1.bcr2016216854.18","doi-asserted-by":"publisher","DOI":"10.1007\/s12291-015-0535-8"},{"key":"2025082802003799000_2016.sep21_1.bcr2016216854.19","first-page":"12","article-title":"Retrospective Analysis of Varied Clinical Presentations and Delayed Diagnosis inTuberculosis affection of Extremities","volume":"2","author":"Vijay","year":"2012","journal-title":"J Orthop Case Rep"},{"key":"2025082802003799000_2016.sep21_1.bcr2016216854.20","doi-asserted-by":"publisher","DOI":"10.5578\/tt.9167"},{"key":"2025082802003799000_2016.sep21_1.bcr2016216854.21","first-page":"93","article-title":"Risk of active tuberculosis in adult household contacts of smear-positive pulmonary tuberculosis cases","volume":"13","author":"Kilicaslan","year":"2009","journal-title":"Int J Tuberc Lung Dis"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2016-216854","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T09:00:51Z","timestamp":1756371651000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2016-216854"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,9,21]]},"references-count":21,"alternative-id":["10.1136\/bcr-2016-216854"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2016-216854","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,9,21]]}}}