Isolated Lacrimal Gland Tuberculosis: A Rare Clinical Entity in a Young Child

Abstract

Discharging sinus in upper eyelid is one of rare manifestations of tuberculosis. The present report describes the youngest case of tubercular dacryoadenitis in an otherwise healthy child. A 4 year old male patient presented with discharging sinus in upper eyelid that developed after a spontaneously burst abscess in upper eyelid. Pus culture was sterile and the child did not improve with antibiotics. The child subsequently developed superotemporal orbital swelling and along with discharging sinus. Debridement and curettage of the necrotic tissue and sequestrum were done, histopathology showed the chronic granulomatous inflammation consistent with tuberculosis. The patient was managed with anti-tubercular therapy for 6 months. Atypical presentations of tuberculosis like discharging sinus in eyelid pose a difficult problem in diagnosis particularly in a young child. Spread of tubercular bacilli to the lacrimal gland is more commonly hematogenous or may occur directly from conjunctival tuberculosis and rarely from direct inoculation during trauma. This case report presents unusual development of tuberculosis with no other local or systemic focus of tubercular infection and any direct trauma. Tuberculosis should be kept as a possible differential diagnosis in cases of painless lid swelling, especially in a country like India where tuberculosis is endemic.

Keywords

• Tuberculosis
• lacrimal gland
• granuloma