Nakamura Kazuyoshi, Horio Yuko, Yamanaka Tohru
Respiratory Department, Taragi Municipal Hospital, Japan.
Kekkaku. 2012 Jul;87(7):501-5.
Ocular tuberculosis is rare. We report a case of orbital myositis suspected to be infected with tuberculosis. In January 2008, a 34-year-old man experienced discomfort in the right eye. In May 2008, this patient developed right exophthalmos, diplopia, and pain in the right eye, and he was diagnosed with idiopathic orbital myositis. The patient underwent 2 courses of steroid pulse therapy; after which, the dosage of steroids was reduced. The steroid treatment reduced the eye pain, but his diplopia and exophthalmos persisted. By November of the same year, his general malaise had increased, and chest X-ray radiography and computed tomography were performed on 3rd December. On the basis of the imaging results, we suspected active pulmonary tuberculosis of the right upper lobe. The smear made by using the sample obtained after bronchial brushing was negative for acid-fast bacilli, but a Mycobacterium tuberculosis nucleic acid amplification test of the post-bronchoscopic sputum yielded positive results. Therefore, the patient was diagnosed with pulmonary tuberculosis. After the 2HREZ/7HR regimen of treatment, the extent of the tuberculosis lesions of the lung was reduced and the exophthalmos and eye pain were alleviated. Orbital myositis is inflammation of the extraocular muscles and can be either idiopathic, without a known etiology, or secondary to conditions such as tuberculosis, sarcoidosis, or hyperthyroidism. Our patient was not definitively diagnosed with tuberculosis of the eye. A definitive diagnosis of tuberculosis of the eye would require detection of granulomatous lesions in the eye or isolation of Mycobacterium tuberculosis by puncturing the eye muscles; however, our findings suggested the possibility that it was secondary to tuberculosis. We think that a careful examination of the chest should be performed for patients with ocular abnormalities.
眼部结核较为罕见。我们报告一例疑似感染结核的眼眶肌炎病例。2008年1月，一名34岁男性右眼出现不适。2008年5月，该患者出现右眼眼球突出、复视及疼痛，被诊断为特发性眼眶肌炎。患者接受了2个疗程的类固醇脉冲治疗，之后类固醇剂量减少。类固醇治疗减轻了眼痛，但复视和眼球突出仍持续存在。同年11月，他的全身不适加重，12月3日进行了胸部X线摄影和计算机断层扫描。根据影像学结果，我们怀疑右上叶有活动性肺结核。支气管刷检样本涂片抗酸杆菌阴性，但支气管镜检查后的痰液结核分枝杆菌核酸扩增试验呈阳性结果。因此，患者被诊断为肺结核。经过2HREZ/7HR治疗方案后，肺部结核病变范围缩小，眼球突出和眼痛减轻。眼眶肌炎是眼外肌的炎症，可分为特发性（病因不明）或继发于结核、结节病或甲状腺功能亢进等疾病。我们的患者未被明确诊断为眼部结核。眼部结核的明确诊断需要在眼部检测到肉芽肿性病变或通过穿刺眼肌分离出结核分枝杆菌；然而，我们的发现提示其可能继发于结核。我们认为对于有眼部异常的患者应仔细检查胸部。
