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  • Title: Tubercular preseptal cellulitis in children: a presenting feature of underlying systemic tuberculosis.
    Author: Raina UK, Jain S, Monga S, Arora R, Mehta DK.
    Journal: Ophthalmology; 2004 Feb; 111(2):291-6. PubMed ID: 15019377.
    Abstract:
    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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