Unilateral giant tarsal papillae as a rare presentation of extrapulmonary tuberculosis

We report a rare case of extrapulmonary tuberculosis as an isolated unilateral giant tarsal papillae. A 30-year-old female presented with persistent unilateral giant tarsal papillae that developed ulceration following a supratarsal steroid injection. There was no regional lymphadenopathy. Incision biopsy showed granulomatous inflammation with giant cells within the tarsal conjunctiva without evidence of acid-fast bacilli or fungus. The patient was evaluated for systemic granulomatous diseases and was found to have a positive Mantoux test and elevated anti-nuclear antibody levels. Meanwhile, she developed submandibular lymph node enlargement, and a biopsy from the lymph node showed caseous necrosis with granulomatous inflammation, which confirmed tuberculosis. She was started on antitubercular therapy, and her eyelid and lymph nodes showed complete resolution, which was maintained until 1 year of follow-up. Primary tuberculous conjunctivitis should be considered in the differential diagnosis of unilateral giant papillae, and steroid injection should be avoided without ruling out infection.