Tubercular preseptal cellulitis in children: a presenting feature of underlying systemic tuberculosis.

Abstract

OBJECTIVE:

To present the clinical findings in 7 patients with preseptal cellulitis caused by tuberculosis.

DESIGN:

Retrospective noncomparative interventional case series.

PARTICIPANTS:

Seven patients.

METHODS:

Review of clinical findings, course, diagnostic tools, and management of 7 cases with tubercular preseptal cellulitis.

MAIN OUTCOME MEASURES:

Healing of local and systemic lesions, cosmetic correction.

RESULTS:

The presenting features of tuberculosis included lid abscess formation in 5 cases, with spontaneous fistulization in 2 patients. Two cases were initially seen with a cicatricial ectropion of the upper lid. A history of a lid swelling with spontaneous fistulization was present in both cases. Nonresponsiveness of the lesions to systemic antibiotics led to a detailed evaluation of the patients, and evidence of an underlying active or healed systemic focus was present in all the cases. Acid-fast bacilli from pus from the discharging sinuses were identified in only 1 case, and in another patient, a biopsy specimen of the submandibular lymph node showed caseation necrosis. In the other cases, the diagnosis was presumptive from a strongly reactive Mantoux test, raised erythrocyte sedimentation rate, and the presence of a systemic focus. All the patients showed a dramatic response with antitubercular treatment, with complete healing of lesions. Two patients had a residual cicatricial ectropion, which was corrected surgically in both cases.

CONCLUSIONS:

Preseptal or lid involvement can be the presenting feature of tuberculosis and a marker for underlying systemic focus in children. Spontaneous fistulization of the abscess, minimal inflammatory signs, nonresponsiveness to antibiotic therapy, tethering to the underlying structures and skin, and the presence of a cicatricial ectropion should alert the clinician to look for an alternate diagnosis. The lid presentation might be a marker of an underlying systemic focus; therefore, awareness of the many faces of tuberculosis is important for ophthalmologists.

• Authors: Usha K Raina, Shailley Jain, Sumit Monga, Ritu Arora, D K Mehta
• Journal: Ophthalmology (Ophthalmology) Vol. 111 Issue 2 Pg. 291-6 (Feb 2004) ISSN: 0161-6420 [Print] United States
• PMID: 15019377 (Publication Type: Journal Article)

Chemical References

• Antitubercular Agents

Topics

• Antitubercular Agents (therapeutic use)
• Cellulitis (diagnosis, drug therapy, microbiology)
• Child
• Child, Preschool
• Diagnosis, Differential
• Drug Therapy, Combination
• Eyelid Diseases (diagnosis, drug therapy, microbiology)
• Eyelids (pathology)
• Female
• Humans
• Infant
• Male
• Mycobacterium tuberculosis (isolation & purification)
• Retrospective Studies
• Tuberculin Test
• Tuberculosis, Ocular (diagnosis, drug therapy, microbiology)
• Tuberculosis, Pulmonary (diagnosis, drug therapy, microbiology)