title: Tubercular preseptal cellulitis in children: a presenting feature of underlying systemic tuberculosis.
abstract: OBJECTIVE
  To present the clinical findings in 7 patients with preseptal cellulitis caused by tuberculosis.
  
  
  METHODS
  Retrospective noncomparative interventional case series.
  
  
  METHODS
  Seven patients.
  
  
  METHODS
  Review of clinical findings, course, diagnostic tools, and management of 7 cases with tubercular preseptal cellulitis.
  
  
  METHODS
  Healing of local and systemic lesions, cosmetic correction.
  
  
  RESULTS
  The presenting features of tuberculosis included lid abscess formation in 5 cases, with spontaneous fistulization in 2 patients. Two cases were initially seen with a cicatricial ectropion of the upper lid. A history of a lid swelling with spontaneous fistulization was present in both cases. Nonresponsiveness of the lesions to systemic antibiotics led to a detailed evaluation of the patients, and evidence of an underlying active or healed systemic focus was present in all the cases. Acid-fast bacilli from pus from the discharging sinuses were identified in only 1 case, and in another patient, a biopsy specimen of the submandibular lymph node showed caseation necrosis. In the other cases, the diagnosis was presumptive from a strongly reactive Mantoux test, raised erythrocyte sedimentation rate, and the presence of a systemic focus. All the patients showed a dramatic response with antitubercular treatment, with complete healing of lesions. Two patients had a residual cicatricial ectropion, which was corrected surgically in both cases.
  
  
  CONCLUSIONS
  Preseptal or lid involvement can be the presenting feature of tuberculosis and a marker for underlying systemic focus in children. Spontaneous fistulization of the abscess, minimal inflammatory signs, nonresponsiveness to antibiotic therapy, tethering to the underlying structures and skin, and the presence of a cicatricial ectropion should alert the clinician to look for an alternate diagnosis. The lid presentation might be a marker of an underlying systemic focus; therefore, awareness of the many faces of tuberculosis is important for ophthalmologists.
authors.affiliation: Pediatric Ophthalmology Service, Guru Nanak Eye Center, Maulana Azad Medical College, New Delhi, India. ajainsjain@yahoo.com
authors.forename: Usha K
authors.initials: UK
authors.lastname: Raina
authors.forename: Shailley
authors.initials: S
authors.lastname: Jain
authors.forename: Sumit
authors.initials: S
authors.lastname: Monga
authors.forename: Ritu
authors.initials: R
authors.lastname: Arora
authors.forename: D K
authors.initials: DK
authors.lastname: Mehta
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D002481:Cellulitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D005141:Eyelid Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D005143:Eyelids / Q000473:pathology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D012189:Retrospective Studies; D014374:Tuberculin Test; D014392:Tuberculosis, Ocular / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents