Al-Malki A F, Issa T M, Riley F, Karcioglu Z A
Department of Ophthalmology, Riyadh Military Hospital, Saudi Arabia.
Ophthalmic Plast Reconstr Surg. 1999 May;15(3):213-6. doi: 10.1097/00002341-199905000-00012.
To present an unusual case of nasolacrimal tuberculosis that was diagnosed with polymerase chain reaction (PCR) and to discuss the role of PCR as a diagnostic aid.
Case presentation with diagnostic modalities including PCR, cytopathologic, and histopathologic examinations with special stains.
A 40-year-old woman with bilateral lacrimal drainage system obstruction underwent a right dacryocystorhinostomy with stents and left conjunctivodacryocystorhinostomy with Jones bypass tube. Although the findings of direct and endoscopic examinations of the nasal cavity were within normal limits, the tissue removed during surgery from the middle turbinate revealed caseating granulomatous lesions on histopathologic examination. Acid-fast organisms were demonstrated in postoperative nasal washings, and Mycobacterium tuberculosis infection was confirmed with PCR.
Primary tuberculosis of the nasolacrimal mucosa is rare, and its occurrence without any symptoms, as in this patient, is even less frequent. The most interesting aspect of this case was the identification of the M. tuberculosis DNA in the mucosa of anterior turbinate and fibrous tissue within the previous surgical site. Histopathologically, the presence of caseating granulomas was seen only in the nasal mucosa, indicating that PCR may be of use in identifying the causative organism even in the absence of typical histopathologic features.
报告一例经聚合酶链反应（PCR）诊断的鼻泪管结核罕见病例，并探讨PCR作为诊断辅助手段的作用。
通过病例报告，介绍包括PCR、细胞病理学和组织病理学检查及特殊染色等诊断方法。
一名40岁双侧泪道引流系统阻塞的女性接受了右侧带支架的泪囊鼻腔吻合术和左侧带琼斯分流管的结膜泪囊鼻腔吻合术。尽管鼻腔直接检查和内镜检查结果均在正常范围内，但手术中从鼻中隔取出的组织在组织病理学检查中显示为干酪样肉芽肿性病变。术后鼻腔冲洗液中发现抗酸菌，PCR证实为结核分枝杆菌感染。
鼻泪管黏膜原发性结核罕见，像该患者这样无任何症状的情况更为少见。该病例最有趣的方面是在前鼻甲黏膜和先前手术部位的纤维组织中鉴定出结核分枝杆菌DNA。组织病理学上，仅在鼻黏膜中发现干酪样肉芽肿，这表明即使在没有典型组织病理学特征的情况下，PCR也可能有助于识别病原体。
