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      Tuberculous Orbital Abscess Associated with Thyroid Tuberculosis

      case-report

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          Abstract

          Purpose

          To report an unusual presentation of tuberculosis.

          Case Report

          A six-year old boy presented with left upper lid swelling of 15 days’ duration and an asymptomatic midline neck mass from 2 months ago. Imaging studies, and microbiologic tests which demonstrated acid-fast bacilli in the fine needle aspirate of the thyroid mass, both confirmed a diagnosis of cold tuberculous thyroid abscess with presumed hematogenous spread to the orbit. The patient demonstrated marked improvement of both lesions with antitubercular drugs.

          Conclusion

          This case illustrates a very rare association of orbital and thyroid tuberculosis.

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          Most cited references12

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          Tuberculosis of the thyroid gland: review of the literature.

          Ertan Bulbuloglu, Harun Ciralik, H. Özdemir … (2006)
          Thyroid tuberculosis (TTB) is a very rare condition, even in countries with a high prevalence of tuberculosis. The aim of this article is to review and retrieve data about thyroid tuberculosis from the English-language literature in order to gain a better understanding of the clinical characteristics of TTB. We performed Medline, PubMed, and library searches using the key words "thyroid tuberculosis," "throid disease," "tuberculosis and thyroid." Reference lists of the articles obtained and previous reviews were also examined. We retrieved 76 cases matching our selection criteria from the search. Review of the cases with TTB revealed a slight female preponderance. The patients reported in the literature ranged in age from 9 to 83 years, with a median age of 40+/-16 years for men and 44+/-17 years for women. In the articles surveyed, TTB presented with a broad spectrum of manifestations, ranging from an isolated nodule to thyrotoxicosis. It seems that diagnosis of thyroid tuberculosis has recently been increasing, perhaps because of the growing incidence of tuberculosis and the diagnostic use of fine-needle aspiration cytology in the diagnosis. Although, in the past, the diagnosis was generally made by the examination of the specimens, at present, fine-needle aspiration cytology seems to be a useful method in diagnosis tuberculous thyroiditis. The role of surgery is limited after the diagnosis. The choice of treatment should be medical antituberculous therapy. Preoperative diagnosis of thyroid tuberculosis is important because of the availability of medical treatment and the limited role of surgery. This condition should be kept in mind in evaluating patients with a thyroid nodule, in communities where the prevalence of tuberculosis is high.
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            Orbital tuberculosis: a review of the literature.

            Usha Kim, Simon Madge, Debraj Shome … (2007)
            To provide an up-to-date review of the clinical presentations, investigations, and management of orbital tuberculosis (OTB). Systematic review of the literature concerning OTB, limiting the results to English-language peer-reviewed journals. Seventy-nine patients from 39 publications were identified as cases of OTB. The condition presents in one of five forms: classical periostitis; orbital soft tissue tuberculoma or cold abscess, with no bony involvement; OTB with bony involvement; spread from the paranasal sinuses; and tuberculous dacryoadenitis. The ocular adnexa, including the nasolacrimal system and overlying skin, may also be involved. Diagnosis can be difficult and may necessitate an orbital biopsy, in which acid-fast bacilli (AFB) and characteristic histopathology may be seen. Growth of Mycobacterium tuberculosis (mTB) from such a specimen remains the gold standard for diagnosis. Ancillary investigations include tuberculin skin tests and chest radiography, but more recently alternatives such as whole blood interferon-gamma immunological tests and PCR-based tests of pathological specimens have proven useful. The management of OTB is complex, requiring a stringent public health strategy and high levels of patient adherence, combined with long courses of multiple anti-tuberculous medications. The interaction of the human immunodeficiency virus (HIV) with TB may further complicate management.
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              Ocular tuberculosis.

              C J Helm, G Holland (2015)
              In recent years tuberculosis has reemerged as a serious public health problem, raising the possibility that tuberculous eye disease may also become more prevalent. The predominant route by which tubercle bacilli reach the eye is through the bloodstream, after infecting the lungs. The pulmonary loci might not be evident clinically or radiographically. The most common manifestation of ocular tuberculosis in patients with pulmonary tuberculosis is choroiditis. Retinal periphlebitis is rarely caused by direct invasion of the retina by tubercle bacilli. Retinal tuberculosis is usually, but not always, secondary to an underlying choroiditis. Tuberculoprotein hypersensitivity may have a role in the pathogenesis of phlyctenulosis and Eales' disease. Both ocular and orbital tuberculosis are usually unilateral. Skin testing should be performed in selected patients based on the clinical presentation and/or a history of exposure to tuberculosis. The specificity of the PPD skin test for Mycobacterium tuberculosis increases with larger skin reactions and with a history of exposure to an active case of tuberculosis. Because of the potential for serious drug toxicities, empiric treatment with antituberculous chemotherapy should be reserved only for those cases that have an identifiable risk of tuberculous disease.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Ophthalmic Vis Res
                Journal ID (publisher-id): JOVR
                Title: Journal of Ophthalmic & Vision Research
                Publisher: Ophthalmic Research Center
                ISSN (Print): 2008-2010
                ISSN (Electronic): 2008-322X
                Publication date (Print): July 2011
                Volume: 6
                Issue: 3
                Pages: 204-207
                Affiliations
                Department of Neuro-Ophthalmology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
                Author notes
                Correspondence to: Kumudini Sharma, MD. Professor of Neuro-Ophthalmology, Department of Neuro-Ophthalmology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Rd., Lucknow 226014, India; Tel: +91 522 2668314/+91 800 4904441; e-mail: kumud@ 123456sgpgi.ac.in
                Article
                Publisher ID: jovr-6-3-204
                PMC ID: 3306106
                PubMed ID: 22454737
                SO-VID: 8d4085b4-17d2-4f78-820b-830426c77bf4
                Copyright statement: Copyright @ 2011
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 09 April 2011
                Date accepted : 25 May 2011
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: cold abscess,orbital tuberculosis,thyroid tuberculosis
                Data availability:
                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: cold abscess, orbital tuberculosis, thyroid tuberculosis

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