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Tubercular preseptal cellulitis in children: a presenting feature of underlying systemic tuberculosis
Usha K Raina1, Shailley Jain, Sumit Monga
1Pediatric Ophthalmology Service, Guru Nanak Eye Center, Maulana Azad Medical College, New Delhi, India. ajainsjain@yahoo.com
Insights
Tuberculosis can manifest as preseptal cellulitis, a serious eyelid infection. Early recognition of specific signs is crucial for timely diagnosis and effective treatment of this systemic disease.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Pediatrics
Background:
- Preseptal cellulitis, an infection of the eyelid and surrounding tissues, can rarely be caused by tuberculosis (TB).
- Identifying TB as the etiology of preseptal cellulitis is critical, especially in children, as it indicates an underlying systemic infection.
Purpose of the Study:
- To describe the clinical presentation, diagnostic challenges, and management outcomes of preseptal cellulitis caused by tuberculosis in seven patients.
- To highlight the importance of considering tuberculosis in cases of atypical preseptal cellulitis.
Main Methods:
- A retrospective case series reviewing seven patients diagnosed with tubercular preseptal cellulitis.
- Analysis included clinical findings, diagnostic methods (microbiology, biopsy, Mantoux test, ESR), treatment, and outcomes.
Main Results:
- Five patients presented with lid abscess formation, two with spontaneous fistulization, and two with cicatricial ectropion.
- All patients had evidence of active or healed systemic TB, and lesions responded dramatically to anti-TB treatment.
- Diagnosis was confirmed by acid-fast bacilli in pus (1 case), lymph node biopsy (1 case), or presumptive based on clinical signs and investigations in others.
Conclusions:
- Preseptal cellulitis can be an initial manifestation of systemic tuberculosis, particularly in children.
- Clinical features such as spontaneous fistulization, minimal inflammation, antibiotic non-responsiveness, and cicatricial ectropion should raise suspicion for TB.
- Ophthalmologists must be aware of the diverse presentations of tuberculosis to ensure accurate diagnosis and management.
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.
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