DR. TANVI GAONKER

Dr.Anju Rastogi, Dr.Ketaki Rajurkar, Dr.Shweta

Abstract

Orbital tuberculoma is not rare but its intracranial extension is relatively rare. Our case presented with a swelling in the superotemporal part of the right orbit. Investigations revealed a high erythrocyte sedimentation rate (ESR) and a Mantoux of 18 x 22 mm. Magnetic Resonance Imaging showed a lesion in the right scalp which extended intracranially. There was osteomyelitis involving the right lateral orbital wall. Fine needle aspiration cytology (FNAC) smear stained positive for acid fast bacilli (AFB), indicating a possible tubercular etiology. Chest X-ray was within normal limits. In view of high ESR, Mantoux of 18 x 22 mm and FNAC proven AFB, a diagnosis of extrapulmonary tuberculosis was made. Anti-tubercular therapy resulted in complete resolution of the swelling in 12 months. The diagnosis in such cases is often presumptive as FNAC is often negative and culture reports take a long time to show growth. Therefore, a high index of suspicion is required for accurate diagnosis.