Korean J Ophthalmol.  2004 Dec;18(2):190-195. 10.3341/kjo.2004.18.2.190.

A Case of Primary Lid Tuberculosis after Upper Lid Blepharoplasty

• Yang JW
• Kim YD

• KMID: 754387
• DOI: http://doi.org/10.3341/kjo.2004.18.2.190

Abstract

Primary lid tuberculosis after lid surgery is a very rare condition and is likely caused by the introduction of bacilli through epithelial injury. Secondary infection, due to direct hematogenous spread or contiguous spread from adjacent structures are more common presentations of lid tuberculosis. The authors experienced a case of primary lid tuberculosis occurring in a 19 year old female after blepharoplasty for making a eyelid crease. Her upper lid skin showed a reddish and non-tender mass lesion measured 3x1 cm, which was diagnosed as the tuberculosis through typical histopathological findings (caseous necrosis), acid-fast bacilli stain and PCR, and treated with anti-tuberculosis medications.

Keyword

acid-fast bacilli; blepharoplasty; caseous necrosis; primary lid tuberculosis; PCR (polymerase chain reaction)

MeSH Terms

Adult
Antitubercular Agents/therapeutic use
Blepharoplasty/*adverse effects
DNA, Bacterial/analysis
Eyelid Diseases/drug therapy/*etiology
Female
Humans
Mycobacterium tuberculosis/*isolation & purification
Polymerase Chain Reaction
Tomography, X-Ray Computed
Treatment Outcome
Tuberculosis, Ocular/drug therapy/*etiology

Figure

• 

  Fig. 1 Photograph showing reddish brown swelling and indurated nodule in the right upper lid.

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  Fig. 2 CT scan reveals diffuse homogenous enhancement of soft tissue density in right upper lid.

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  Fig. 3 Histopathologic examination demonstrating lymphocytic infiltration into perivascular area (arrow) (×200, H&E).

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  Fig. 4 After the two week radiation therapy, a newly developed nodular mass lesion was detected.

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  Fig. 5 After biopsy, the mass size gradually increased, and showed more lid swelling and even skin defect had developed.

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  Fig. 6 Epithelioid granuloma with central caseous necrosis (arrow) (×100, H&E). B: A few acid fast bacilli (arrow) are seen in AFB stain (×400, AFB stain). C: PCR (polymerase chain reaction) demostrates M. tuberculosis.

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  Fig. 7 After 9 months of INH and rifampin therapy, a large skin defect was left on the upper lid and we will directly repaired lid defect.

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