Mittal Ruchi, Sharma Savitri, Rath Suryasnata, Barik Manas Ranjan, Tripathy Devjyoti
a Ophthalmic Pathology Services , LV Prasad Eye Institute , Bhubaneswar , Odisha , India.
b Ocular Microbiology Services , LV Prasad Eye Institute , Bhubaneswar , Odisha , India.
Orbit. 2017 Oct;36(5):264-272. doi: 10.1080/01676830.2017.1337169. Epub 2017 Jul 5.
This article describes the clinicopathological correlation and challenges encountered in the diagnosis of orbital tuberculosis (TB). Retrospective, interventional case series. A chart review of six patients who underwent biopsy for an orbital mass between January 2012 and December 2013 was performed. Institutional review board approval was obtained for the study. Clinical, radiological, and laboratory findings were documented, and response to antitubercular therapy (ATT) was noted. Age at presentation ranged from 18 to 64 years and duration of complaints varied from 2 weeks to 2 months. Pain, redness, and swelling with an orbital mass on computerized tomography (CT) were the common features. None of the patients was clinically suspected to have orbital TB at presentation. History of prior contact with a patient of TB and history of prior TB were present in one case each. Chest radiography (CXR) showed pulmonary consolidation in one case. Tuberculin skin test (TST) readings ranged from nonreactive to 23 mm. The presence of sputum acid fast bacilli (AFB) was tested in three cases and was negative. Polymerase chain reaction (PCR) for MPB64 gene was positive in all six cases. All cases responded to ATT. Clinical presentation of orbital TB can be variable and can simulate conditions like inflammatory disease and malignancy. Biopsy with histopathology plays a key role in diagnosis. Supportive laboratory investigations are necessary to clinch the diagnosis in cases where histopathology is suggestive of TB. In this regard, PCR for Mycobacterium tuberculosis (MTB) on tissue biopsy specimens may be a sensitive diagnostic tool.
本文描述了眼眶结核（TB）诊断中遇到的临床病理相关性及挑战。回顾性、干预性病例系列研究。对2012年1月至2013年12月期间因眼眶肿物接受活检的6例患者进行了病历回顾。本研究获得了机构审查委员会的批准。记录了临床、放射学和实验室检查结果，并观察了抗结核治疗（ATT）的反应。就诊时年龄在18至64岁之间，主诉持续时间从2周至2个月不等。疼痛、发红、肿胀以及计算机断层扫描（CT）显示眼眶肿物是常见特征。所有患者就诊时临床均未怀疑患有眼眶结核。仅1例患者有既往与结核患者接触史，另1例有既往结核病史。胸部X线摄影（CXR）显示1例有肺部实变。结核菌素皮肤试验（TST）读数范围从无反应至23毫米。3例患者检测了痰抗酸杆菌（AFB），结果均为阴性。所有6例患者MPB64基因的聚合酶链反应（PCR）均为阳性。所有病例对抗结核治疗均有反应。眼眶结核的临床表现可能多种多样，可类似炎症性疾病和恶性肿瘤等情况。组织病理学活检在诊断中起关键作用。在组织病理学提示结核的病例中，支持性实验室检查对于确诊是必要的。在这方面，组织活检标本上的结核分枝杆菌（MTB）PCR可能是一种敏感的诊断工具。
