Results from autoinoculation of mycobacteria into the periorificial skin and mucous membranes in patient with advanced TB. Underlying disease can be pulmonary,intestinal or genitourinary Tb. Infectious mycobacteria shed from these foci are inoculated into surrounding mucous membranes and skin. Tuberclin sensitivity is strong and patients are typically older men. The tip and lateral margin of the tongue are affected most frequently. Lesions start as red papules that evolve into painful,soft punched out shallow ulcers. Usually patients that develop orificial TB have severe internal organ disease and appearance of this lesion portends a poor prognosis.http://en.wikipedia.org/wiki/Tuberculosis_cutis_orificialis 
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