The many faces of tuberculosis

Abstract

Tuberculosis (TB) presenting as multifocal cystic lesions of bone (Jungling's disease) with an intra-orbital mass and calvarial involvement is rare, especially in an immunocompetent host. A 3-year-old boy presented with acute-onset, painless, intra-orbital swelling of the right eye and bony lesions over the right tibia and frontal bone. Tubercular etiology could be established with the help of the Xpert MTB/RIF test, which was performed on pus aspirated from the orbital lesion. The child improved upon antitubercular treatment. Atypical presentations of TB in children are highly variable and might include multifocal osteolytic lesions and intraorbital abscesses. Use of appropriate diagnostic methods, along with timely intervention, leads to a favorable outcome.

Keywords: Intraorbital abscess; Jungling's disease; Pediatric.

Fig. 1

A. Soft, fluctuant swelling at the outer canthus of the right eye with slight redness and a pea-sized, firm swelling over the forehead (black arrow); Image B. Plain CT scan of the head and orbits showing a hypodense, focal, lytic lesion with an associated periosteal reaction involving the right zygoma with contiguous extra-conal soft tissue thickening and a small lytic lesion in the frontal bone with associated mild soft tissue thickening; C. The swelling in both the right eye and forehead completely subsided after 6 months of antitubercular therapy.

Fig. 2

A. An ill-defined, firm, tender swelling over the right tibia (black arrow) without any evidence of inflammation; B. X-ray images (lateral and antero-posterior) of the right tibia showing an ill-defined lytic bony defect in the medulla of the mid-diaphysis with a surrounding thick periosteal reaction.