Orbital tuberculosis masquerading as lymphoma
Author: Li Yen Goh
Base Hospital / Institution: Moorfields Eye Unit at Croydon
ePoster presentation
Abstract ID: 24-441
Purpose
A 32-year-old black female presented to the Eye Casualty with 3 weeks of right periocular pain, swelling and redness, conjunctival injection, blurred vision and diplopia. She had a history of mild asthma but was on no prescription medications.
Methods
Clinical exam showed right proptosis, globally limited eye movements and a subtle right RAPD. Visual acuity (VA) was 6/12 right eye and 6/5 left eye, intraocular pressure was 23mmHg on both sides. Magnetic resonance imaging demonstrated an extensive, abnormal isointense lobulated retro-orbital lesion involving the inferior medial aspect of the right orbit encasing the inferior and medial recti muscles, though not expanding intracranially. Orbital lymphoma was highly suspected prompting haematology multidisciplinary team discussion and hospital admission. The patient received 5 days of oral prednisolone 60mg OD to minimise orbital inflammation. Chest, abdomen and pelvis computed tomography identified enlarged mediastinal lymph nodes with no lung parenchymal disease. Comprehensive blood tests revealed only slightly raised C-reactive protein at 8.4mg/L.
Results
A right orbital biopsy and tissue debulk was performed confirming florid necrotising granulomatous inflammation suggestive of tuberculosis (TB). Treatment with rifampicin, ethambutol and pyridoxine, alongside systemic prednisolone was initiated resulting in resolution of RAPD, restoration of full eye movements and improvement in VA of the right eye to 6/7.5.
Conclusion
Even in endemic areas orbital TB is uncommon, and diagnosis is challenging without a biopsy. TB and lymphoma have been mistaken for one another in various organs including the lungs, lymph nodes, liver, spleen, spine and large muscle groups, sometimes with regrettable consequences, particularly when lymphoma is diagnosed and treated as TB, delaying treatment and in cases where TB was mistaken for lymphoma; chemotherapy and radiotherapy were unnecessarily administered. This case highlights the importance of diagnostic biopsy prior to the initiation of treatment as these two conditions can easily masquerade as one another.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Pari N. | Shams | Moorfields Eye Unit at Croydon |
