ORBITAL TUBERCULOSIS : A CASE REPORT

We report the case of a 39-year-old patient with a history of tuberculosis contagion 2 years ago and having consulted for swelling of the upper part of the face.

 

Ophtalmology A department, hospital of speciality of Rabat

 

The onset of symptoms dates back to 4 months before admission with the onset of periorbital heaviness and pain, then the appearance of swelling in the glabellar region, eyelids and cheeks, then the appearance a few weeks later of multiple fistulas in inner canthi of the eyelids, leaving a slightly lumpy liquid.

The ophthalmologic examination found visual acuity preserved and strictly normal anterior and posterior segments.Computerized tomography (CT) scan of the orbit and head showed a process occupying the frontal and maxillary sinuses, with lysis of the internal wall of the frontal sinuses, the glabellar region, the supero anterior part of the cheeks, pushing the eyeballs out. The eyeballs are unharmed. (Picture 2)Skin biopsy of the glabellar region shows a direct negative bacteriological examination, but histological examination showed a dense inflammatory infiltrate comprising epitheliogigantocellular granulomas with caseous necrosis. The IDR in this patient was strongly positive with accelerated SV. The search for BK in sputum came back negative. The HIV serology was negative.The diagnosis of osteosinus tuberculosis was made due to the history of pulmonary tuberculosis, the presence of fistulas, the result of the histological study, and the strongly positive IDR.The patient was put on antibacillary treatment, according to the protocol: rifampicin (600mg / d), isoniazid (300mg / d), pyrazynamide (1500mg / d), ethambutol (1200mg / d), streptomycin (1g / d) for 2 months , then rifampicin and isoniazid for 10 months, therefore a total duration of 12 months.The outcome was spectacular with almost complete healing clinically and radiologically, but with persistent sinus mucosa hypertrophy, as well as scar-like tissue in the glabellar region.

There is a large clinical polymorphism and tuberculosis should be considered in the presence of unexplained inflammation of the orbit.