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| CASE REPORT |
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| Year : 2020 | Volume
: 9
| Issue : 3 | Page : 332-334 |
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Bilateral tuberculous dacryoadenitis
Rabie Ayari1, Raja Amri2, Emna Chalbi3, Mohamed Ali Sbai1
1 Department of Plastic, Hand Surgery and Burns, Maamouri Hospital, Nabeul; Medical University of Tunis Manar, Tunis, Tunisia
2 Department of Internal Medicine, Maamouri Hospital, Nabeul, Tunisia
3 Department of Anatomic Pathology, Maamouri Hospital, Nabeul, Tunisia
| Date of Submission | 17-Mar-2020 |
| Date of Decision | 20-May-2020 |
| Date of Acceptance | 14-Jun-2020 |
| Date of Web Publication | 28-Aug-2020 |
Correspondence Address:
Mohamed Ali Sbai
Department of Plastic, Hand Surgery and Burns, Maamouri Hospital, Nabeul
Tunisia
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijmy.ijmy_57_20
Tuberculosis is a real public health problem in developing countries. The ophthalmic form is a rare clinical entity. Dacryoadenitis presents an exceptional manifestation. We report the case of a 45-year-old female who presented with a 1-month history of painless bilateral dacryoadenitis with a normal initial work-up. Anatomopathological examination of the lacrimal glandular tissue showed a gigantic epithelioid granuloma with caseous necrosis confirming the diagnosis of tuberculosis. The search for a primary focus was negative. Evolution was good under anti-tuberculosis chemotherapy. The objective of this work is to think of the tuberculous etiology when having dacryoadenitis in an endemic country.
Keywords: Bilateral dacryoadenitis, Mycobacterium tuberculosis, ophthalmic tuberculosis, tuberculosis, tuberculous dacryoadenitis
How to cite this article:
Ayari R, Amri R, Chalbi E, Sbai MA. Bilateral tuberculous dacryoadenitis. Int J Mycobacteriol 2020;9:332-4 |
| Introduction | |  |
Tuberculosis is an infectious disease and a real public health problem. It is endemic in developing countries. Tunisia is a country with an intermediate endemicity with an incidence rate of 35/100,000 in 2019.[1] Extrapulmonary tuberculosis represents 15%–30% of all locations.
Ophthalmic tuberculosis is a rare entity and has no specific clinical presentation.[2]
Bilateral tuberculosis dacryoadenitis is an exceptional form.
The diagnosis remains anatomopathological with a good evolution under anti-tuberculous chemotherapy. A review of the literature is also made.
| Case Report | | |
We report the case of a 45-year-old female with no history, presented with a 1-month history of painless bilateral palpebral swelling. There were no other associated signs such as redness, discharge, or impairment of visual acuity. She did not have other complaints such as weight loss, asthenia, fever, or night sweats [Figure 1].
Physical examination showed isolated bilateral dacryoadenitis. The biological balance was normal.
Anatomopathological examination of the lacrimal glandular tissue revealed a gigantic epithelioid granuloma with caseous necrosis [Figure 2]. | Figure 2: Anatomopathological examination of the lacrimal glandular tissue revealing a gigantic epithelioid granuloma with caseous necrosis
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The search for other tuberculosis foci was negative.
Anti-tuberculous drug therapy based on isoniazid, rifampicin, ethambutol, and pyrazinamide was started for a total of 6 months with complete regression of the palpebral swelling [Figure 3]. | Figure 3: Patient healed after being treated with anti tuberculous chemotherapy
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| Discussion | | |
Dacryoadenitis is an inflammation of the lacrimal glands. Cocci-gram-positive germs are the most incriminated in chronic forms.
Ophthalmic tuberculosis is a rare clinical entity with an incidence varying from 1.4% to 18% according to the studies.[2]
Dacryoadenitis is the least common presentation. The bilateral form is exceptional and only mentioned in some case reports.[3],[4]
We believe that the dissemination of tuberculosis to the lacrimal gland is hematogeneous caused by hilar lymph nodes rupture in the pulmonary veins.[5] Bacilli are carried by the bloodstream to the lacrimal gland and remain silent until there is a drop in the immune system function.[2]
Nevertheless, local spread to the lacrimal gland can also occur from the conjunctiva or paranasal sinuses, as well as directly by air or eye when in contact with contaminated hands or sputum particles containing the bacilli[6] (probably the contamination mode of our patient).
In our case, the search for a primary focus is negative.
There is no typical presentation of tuberculous dacryoadenitis. Usually, there is a bilateral asymmetrical swelling causing deformation of the upper eyelid in the shape of an “S,” with progressive discomfort when mobilizing eyes.
Orbital computed tomography scan may show enlargement of the lacrimal glands or an abscess.[6] Bone destruction can be seen.[4]
The anatomopathological study is the key examination to confirm the diagnosis by showing a gigantic epithelioid granuloma with caseous necrosis specific for tuberculosis.
The treatment of tuberculous dacryoadenitis is essentially medical, with anti-tuberculous chemotherapy based on isoniazid, rifampicin, ethambutol, and pyrazinamide for a duration of 6–9 months,[7] with an excellent prognosis.
Our patient was treated with anti-tuberculosis drugs with complete disappearance of the palpebral swelling.
| Conclusion | | |
Dacryoadenitis is a rare presentation of tuberculosis. It must be thought of, when having an atypical form in an endemic country. Biopsy confirms the diagnosis by objectifying the tuberculoid granuloma with caseous necrosis. Medical treatment based on anti-tuberculous chemotherapy allows healing.
Disclaimer
The products used for this research are commonly and predominantly use products in our area of research and country. There is absolutely no conflict of interest between the authors and producers of the products because we do not intend to use these products as an avenue for any litigation but for the advancement of knowledge. Also, the research was not funded by the producing company rather it was funded by personal efforts of the authors.
Consent and ethical approval
As per university standard guidelines, participant consent and ethical approval have been collected and preserved by the authors.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | World Health Organization. Global Tuberculosis Report 2019.  |
| 2. | Colombier R, Crisinel PA, Cohen-Dumani N, Ceschi G. Bilateral dacryoadenitis: Don't forget tuberculosis! Pediatr Infect Dis J. 2017;36:117-9. |
| 3. | Abrol R, Nagarkar NM, Mohan H, Srivastava M. Primary bilateral tuberculous dacryocystitis with preauricular lymphadenopathy: A diagnostic difficulty of recent times. Otolaryngol Head Neck Surg 2002;126:201-3. |
| 4. | Rezzoug B, Tzili N, Ali H, Elyamouni O, El Khaoua M, Elorch H, et al. Bilateral tuberculous dacryoadenitis: About a case. Pan Afr Med J 2015;20:26. |
| 5. | Sbai MA, Benzarti S, Msek H, Boussen M, Khorbi A. Pseudotumoral form of soft-tissue tuberculosis of the wrist. Int J Mycobacteriol 2016;5:99-101. [Full text] |
| 6. | Narula MK, Chaudhary V, Baruah D, Kathuria M, Anand R. Pictorial essay: Orbital tuberculosis. Indian J Radiol Imaging 2010;20:6-10. [ PUBMED] [Full text] |
| 7. | Figueiraa L, Fonsecaa S, Ladeira IB, Duarte R. Ocular tuberculosis: Position paper on diagnosis and treatment management. Pulmonology Journal 2017;23:31-8. |
[Figure 1], [Figure 2], [Figure 3]
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