Orbital and adnexal tuberculosis: a case series from a South Indian population

Abstract

Background: Orbital tuberculosis (OTb) is rare and may be regarded as a manifestation of extrapulmonary tuberculosis. We report an interesting case series of six patients with varied presentations of orbital and adnexal tuberculosis in a South Indian patient population.

Results: A retrospective, interventional case series of six patients diagnosed with orbital and adnexal tuberculosis on the basis of clinical, radiological and histopathological evaluations between 2010 and 2013 was performed. Among the six patients with histopathologically proven OTb, five were women. The varied presentations included tubercular dacryoadenitis (two cases), classical periostitis (two cases), OTb with bone involvement (one case) and ocular adnexal tuberculosis (one case). Systemic involvement was seen in one case. All cases were treated with a regimen of antitubercular therapy (ATT).

Conclusions: OTb, though rare, should form a part of the differential diagnosis of orbital lesions in a high tuberculosis (TB) endemic country like ours. Biopsy still remains the mainstay of diagnosis.

Keywords: Antitubercular therapy; Mycobacterium tuberculosis; Orbital tuberculosis; Proptosis.

Figure 1

Examination results of case 1. (A) Face photograph of case 1 showing fullness along the lateral orbital rim with ptosis especially laterally (arrow). (B) External photograph showing sites of abscess drainage (scars) in the supraclavicular region and arm (arrows). (C) Computed tomography scan of the orbits showing lytic lesion in the bone with sequestration. (D) Photograph showing the pus collected and the chronic granulomatous inflammation on histopathology showing caseation necrosis.

Figure 2

Examination results of case 2. (A) Face photograph of case 2 showing fullness below the lateral part of the left eye brow in the lacrimal gland area (arrow). (B) CT scan showing diffuse enlargement of the lacrimal gland, without bony erosion or bony remodelling. (C) Photomicrograph showing granulomatous inflammation with caseation necrosis (arrow).

Figure 3

Examination results of case 3. (A) Face photograph of case 3 showing fullness below the lateral part of the right eye brow. (B) CT scan showing diffuse enlargement of the lacrimal gland (arrows) without any bony erosion or remodelling. (C) Microphotograph showing the chronic granulomatous inflammation with giant cells (arrow) and caseation necrosis (H&E).

Figure 4

Examination results of case 4. (A) Face photograph of case 4 showing an indurated mass lesion with an overlying non-healing ulcer with discharge in the lacrimal sac area of the right eye (arrow). (B) CT scan showing soft tissue lesion in the anterior part of right medial orbit (arrow). (C) Photomicrograph showing chronic granulomatous inflammation with giant cells (arrow).

Figure 5

Examination results of case 5. (A) Face photograph of case 5 showing a preseptal swelling below the left superior orbital rim (arrow). (B) CT scan of the orbits showing soft tissue swelling in front of the superior orbital rim with no evidence of bony erosion (arrow). (C) Photomicrograph showing chronic granulomatous inflammation with giant cells and caseation necrosis (arrow).

Figure 6

Examination results of case 6. (A) Face photograph of case 6 showing large ulceration on the right cheek below the right lower eyelid. Microphotograph showing (B) chronic granulomatous inflammation with giant cells and caseation necrosis and (C) positive acid fast bacilli indicated by an arrow.