Objective: To report a case of multifocal pediatric tuberculosis presenting with mandibular swelling and discuss its etiology, clinical findings, diagnosis, management, and outcome after treatment.

Methods:

Design: Case Report

Setting: Tertiary Government Training Hospital

Patient: One

Results: A 3-year-old boy presented with progressive non-tender, right mandibular swelling for 11 months. Panoramic X-ray exhibited extensive multiple loculations with lytic changes on the mandible. CT Scans revealed a peripherally enhancing hypodense mass with lytic expansion of the right mandibular angle extending across the left mandibular body with an incidental finding of right lung mass. Other extrapulmonary lesions were also detected involving the scapula, pleura with lysis of the adjacent ribs at the level of T7 and T8. Biopsy of the mandibular and lung mass confirmed the presence of caseating and non-caseating granulomas consistent with Koch's infection. The patient showed significant improvement by the 7th month of a 12-month course of anti-tuberculous therapy.

Conclusion: Multifocal TB can present as simple mandibular swelling, and a thorough workup should look for other involved sites. Early diagnosis in children may prevent debilitating sequelae and improve long-term treatment outcomes.