Solmaz Nilgün, Önder Feyza, Demir Nedime, Altuntaş Aydın Özlem
University of Health Sciences, Haseki Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey.
University of Health Sciences, Dr. Sadi Konuk Training and Research Hospital, Infectious Disease and Clinical Microbiology Clinic, İstanbul, Turkey.
Turk J Ophthalmol. 2018 Feb;48(1):39-41. doi: 10.4274/tjo.66592. Epub 2018 Feb 23.
A 12-year-old girl was referred to our clinic because of unilateral conjunctivitis not responding to treatment. In the left eye, lower bulbar and tarsal conjunctiva had a polypoidal appearance due to micronodules and there was a subconjunctival nodular mass in the inferior fornix. Systemic examination was unremarkable except for a left preauricular lymphadenopathy. Excision biopsy of the subconjunctival mass revealed a granulomatous inflammation with caseation necrosis, but acid-fast bacilli (AFB) was negative. Fine needle-aspiration biopsy of the preauricular lymph node was performed. In microbiological examination, both AFB and mycobacterial culture were positive. The isolated mycobacteria strains were identified as complex and full remission was achieved with 6 months of anti-tuberculosis treatment. Although primary tuberculous conjunctivitis is a very rare condition, it should be considered in the differential diagnosis of treatment-resistant unilateral conjunctivitis. For definitive diagnosis, microbiological and histopathological examinations should be performed both in conjunctiva and regional lymph node.
一名12岁女孩因单侧结膜炎治疗无效被转诊至我们的诊所。左眼下部球结膜和睑结膜因小结节呈息肉样外观，下穹窿有一个结膜下结节状肿物。全身检查除左侧耳前淋巴结肿大外无异常。结膜下肿物切除活检显示为伴有干酪样坏死的肉芽肿性炎症，但抗酸杆菌（AFB）阴性。对耳前淋巴结进行了细针穿刺活检。微生物学检查显示AFB和分枝杆菌培养均为阳性。分离出的分枝杆菌菌株被鉴定为结核分枝杆菌复合群，经过6个月的抗结核治疗实现了完全缓解。虽然原发性结核性结膜炎是一种非常罕见的疾病，但在治疗抵抗性单侧结膜炎的鉴别诊断中应予以考虑。为明确诊断，应在结膜和区域淋巴结进行微生物学和组织病理学检查。
