J Korean Ophthalmol Soc.  2017 Jul;58(7):862-865. 10.3341/jkos.2017.58.7.862.

A Case of Bilateral Orbital Tuberculosis

• Ahn HM
• Kie JH
• Kim HY

• KMID: 2387162
• DOI: http://doi.org/10.3341/jkos.2017.58.7.862

Abstract

PURPOSE
Periocular tuberculosis is common in the form of conjunctival tuberculosis or uveitis; however, orbital tuberculosis is very rare. We report a case of tuberculosis diagnosed based on bilateral orbital masses.
CASE SUMMARY
A 64-year-old male with a history of diabetes, hypertension, and chronic obstructive pulmonary disease presented with diplopia. His best-corrected visual acuity was 1.0, and intraocular pressure was 16 mmHg in both eyes. Bilateral proptosis was noted, and inferior orbital masses were palpated in both eyes. On orbital computed tomography, irregular masses were surrounding both globes in the extraconal space. Incisional biopsy of the bilateral orbital masses was performed under local anesthesia. Pathologic examination revealed chronic granulomatous inflammation accompanied by caseous necrosis. The patient was diagnosed with bilateral orbital tuberculosis and underwent triple therapy with isoniazid, rifampin, and ethambutol for 12 months. The orbital masses completely resolved, and there was no recurrence or complication through 12 months after treatment.
CONCLUSIONS
To our knowledge, bilateral orbital tuberculosis has not been reported yet. Herein, we report a case of orbital tuberculosis presenting as bilateral orbital masses.

Keyword

Orbital inflammation; Orbital mass; Orbital tuberculosis; Tuberculosis

MeSH Terms

Anesthesia, Local
Biopsy
Diplopia
Ethambutol
Exophthalmos
Humans
Hypertension
Inflammation
Intraocular Pressure
Isoniazid
Male
Middle Aged
Necrosis
Orbit*
Pulmonary Disease, Chronic Obstructive
Recurrence
Rifampin
Tuberculosis*
Uveitis
Visual Acuity
Ethambutol
Isoniazid
Rifampin

Figure

• 

  Figure 1. Initial contrast enhanced orbital computed tomography scan. Ill-defined irregular masses (arrows) were noted in both orbits. The masses were located in extraconal space and surrounding the eyeball (A, Coronal view; B, Axial view).

• 

  Figure 2. Histopathologic examination. Granulomatous inflammation with central geographic necrosis is observed. A Langhans-type giant cell (arrow) is noted (H&E, ×200).

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  Figure 3. Nine-month post-treatment orbital computed tomography scan. There was no evidence of residual or recurred orbital tuberculosis (A, Coronal view; B, Axial view).

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