Orbital tuberculosis: Clinicopathological correlation and diagnosis using PCR in formalin-fixed tissues

Orbit. 2017 Oct;36(5):264-272. doi: 10.1080/01676830.2017.1337169. Epub 2017 Jul 5.


This article describes the clinicopathological correlation and challenges encountered in the diagnosis of orbital tuberculosis (TB). Retrospective, interventional case series. A chart review of six patients who underwent biopsy for an orbital mass between January 2012 and December 2013 was performed. Institutional review board approval was obtained for the study. Clinical, radiological, and laboratory findings were documented, and response to antitubercular therapy (ATT) was noted. Age at presentation ranged from 18 to 64 years and duration of complaints varied from 2 weeks to 2 months. Pain, redness, and swelling with an orbital mass on computerized tomography (CT) were the common features. None of the patients was clinically suspected to have orbital TB at presentation. History of prior contact with a patient of TB and history of prior TB were present in one case each. Chest radiography (CXR) showed pulmonary consolidation in one case. Tuberculin skin test (TST) readings ranged from nonreactive to 23 mm. The presence of sputum acid fast bacilli (AFB) was tested in three cases and was negative. Polymerase chain reaction (PCR) for MPB64 gene was positive in all six cases. All cases responded to ATT. Clinical presentation of orbital TB can be variable and can simulate conditions like inflammatory disease and malignancy. Biopsy with histopathology plays a key role in diagnosis. Supportive laboratory investigations are necessary to clinch the diagnosis in cases where histopathology is suggestive of TB. In this regard, PCR for Mycobacterium tuberculosis (MTB) on tissue biopsy specimens may be a sensitive diagnostic tool.

Keywords: Histopathology; PCR; orbital; tuberculosis.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Adult
  • Antigens, Bacterial / genetics
  • Antitubercular Agents / therapeutic use
  • Bacterial Proteins / genetics
  • DNA, Bacterial / genetics
  • Eye Infections, Bacterial / diagnosis*
  • Eye Infections, Bacterial / drug therapy
  • Eye Infections, Bacterial / genetics
  • Female
  • Fixatives
  • Formaldehyde
  • Humans
  • Male
  • Middle Aged
  • Mycobacterium tuberculosis / isolation & purification
  • Orbital Diseases / diagnosis*
  • Orbital Diseases / drug therapy
  • Orbital Diseases / genetics
  • Polymerase Chain Reaction
  • Radiography, Thoracic
  • Retrospective Studies
  • Sputum / microbiology
  • Tissue Fixation
  • Tomography, X-Ray Computed
  • Tuberculin Test
  • Tuberculosis, Ocular / diagnosis*
  • Tuberculosis, Ocular / drug therapy
  • Tuberculosis, Ocular / genetics
  • Tuberculosis, Pulmonary / diagnosis
  • Young Adult


  • Antigens, Bacterial
  • Antitubercular Agents
  • Bacterial Proteins
  • DNA, Bacterial
  • Fixatives
  • MPB64 protein, Mycobacterium
  • Formaldehyde