The many faces of tuberculosis

Tuberculosis (TB) presenting as multifocal cystic lesions of bone (Jungling's disease) with an intra-orbital mass and calvarial involvement is rare, especially in an immunocompetent host. A 3-year-old boy presented with acute-onset, painless, intra-orbital swelling of the right eye and bony lesions over the right tibia and frontal bone. Tubercular etiology could be established with the help of the Xpert MTB/RIF test, which was performed on pus aspirated from the orbital lesion. The child improved upon antitubercular treatment. Atypical presentations of TB in children are highly variable and might include multifocal osteolytic lesions and intraorbital abscesses. Use of appropriate diagnostic methods, along with timely intervention, leads to a favorable outcome.