Tuberculosis presenting as dacryoadenitis in the USA

Abstract

A 25-year-old Filipino woman living in the USA was evaluated for a 5-month history of left eye pain and a subsequent orbital mass. Histopathological analysis of the lacrimal mass showed a mixed inflammatory process with necrotising granulomas and positive cultures for Mycobacterium tuberculosis. She was treated with antituberculosis therapy, with resolution of symptoms. Tuberculosis dacryoadenitis is extremely rare in the USA and other developed countries. It requires a high degree of clinical suspicion with special attention to the patient’s history to make the correct diagnosis. It can be treated successfully with antituberculosis therapy.

Infectious Dacryoadenitis: A Comprehensive Review

“…45 In the absence of culture growth from biopsied tissue, traditional diagnostic testing for TB such as acid fast bacterial cultures from sputum and a chest radiograph may be useful in making the presumptive diagnosis of tuberculous dacryoadenitis. 47 The recommendations for treatment of nonpulmonary TB are the same as for pulmonary TB. A standard treatment regimen for TB includes rifampin, isoniazid, pyrazinamide, and ethambutol for 2 months, followed by rifampin and isoniazid for 4 months.…”

“…Of note, mycobacterial cultures and M. tuberculosis PCR can have poor sensitivity, so negative culture or PCR results do not necessarily rule out the disease 45. In the absence of culture growth from biopsied tissue, traditional diagnostic testing for TB such as acid fast bacterial cultures from sputum and a chest radiograph may be useful in making the presumptive diagnosis of tuberculous dacryoadenitis 47…”