Histologically confirmed ocular tuberculosis: an unusual case and review of literature

Abstract

Ocular tuberculosis (OTB) is the first cause of ocular inflammation of infectious origin in developing countries. It can affect all structures of the eye without pathognomonic presentation. Its diagnosis remains challenging owing to the difficulty of sampling for histopathological and microbiological investigations. A 36-year-old male patient with no previous medical history was admitted for a scleral mass in his right eye, which was diagnosed elsewhere 45 days before. On examination, a minimal intraocular inflammatory reaction and right eyelid swelling were noted. A scleral lesion in the superior nasal quadrant of the right eye was observed and was responsible for globe displacement inferolaterally and for restricted eye motility. An excision biopsy of the suspicious lesion was made. Histological examination revealed a tuberculous granuloma associated with caseous necrosis. Sputum smear result was negative for Mycobacterium tuberculosis. Further investigations excluded extra-OTB involvement. The patient received 6 months of antitubercular therapy. The disease evolution was favorable. The authors also reviewed all reported cases of histologically confirmed OTB in the literature by search in PubMed till December 2019. Cases with histopathology results revealing granulomatous inflammation without caseous necrosis and cases of tubercular dacryoadenitis were excluded from the search, at enrollment.