REVISITING PRESUMPTIVE CONJUNCTIVAL TUBERCULOSIS: A CASE OF PUZZLING CONJUNCTIVAL SWELLING
Sai Priyalatha M, Punithamalar V, Wan Mohd Hafidz W. & Bastion M.L.C.
abstract
A 15-20-year-old male presented with a two-week history of left eye redness and swelling. He reported no constitutional symptoms, tuberculosis (TB) contact, ocular trauma, or foreign body entry. Bilateral visual acuity was 6/9. Examination of the left eye revealed subconjunctival nodular masses at the superonasal bulbar, tarsal conjunctiva, and inferotemporal tarsal conjunctiva. The cornea, anterior chamber, and fundus were normal, and the right eye examination was unremarkable. Systemic examination identified swelling of the left preauricular, submandibular, and multiple cervical lymph nodes. Excisional biopsy of the subconjunctival mass showed suppurative granulomatous inflammation with a few Langhans multinucleated giant cells, but acid-fast bacilli (AFB) and fungal elements were negative. Gram staining revealed a few polymorphs. Fine-needle aspiration biopsy of the preauricular lymph node also showed chronic granulomatous inflammation, though TB-PCR was negative. Investigations, including white cell count, erythrocyte sedimentation rate (ESR), VDRL, chest X-ray, and Mantoux test, were normal. The patient completed two weeks of oral doxycycline and one week of oral amoxicillin/clavulanic acid but showed no improvement. He also failed to respond to topical antibiotics or steroids. Upon review by a chest physician, he was treated as presumed conjunctival TB and started on anti-tuberculosis therapy, leading to the complete resolution of the conjunctival nodules and lymph node swelling.
references
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