Orbital cellulitis in pulmonary tuberculosis: A case report

Abstract

Background: Orbital cellulitis in immunocompetent patients with pulmonary tuberculosis (TB) is rare or unheard of. If left untreated, patients might lose their sight and potentially their life. This case describes orbital cellulitis due to extended spectrum β-lactamases (ESBLs)-producing bacteria in a patient with pulmonary tuberculosis.
Materials and Methods: We report the case of a 47-year-old man referred to the emergency room in our hospital with swollen and painful right eye and face for 8 days. On admission, the patient condition was drowsy, pale, and feverish. Visual acuity of the right eye was only light perception with limited eye movement in all directions. The CT scan showed orbital sub-tissue swelling and sub-periosteal abscess on the upper lateral orbital wall. On day 5, pus culture was confirmed as extended spectrum β-lactamases (ESBLs) producing bacteria and Ziehl-Neelson staining test revealed acid fast bacillus with pulmonary inflammation highly pathognomonic of tuberculosis.
Results: The patient showed significant clinical improvement on day 11. The patient was discharged on the day 15 in stable general condition with improved visual acuity on the right eye (capable of capturing hand movement).
Conclusion: ESBL producing bacteria associated orbital cellulitis in tuberculosis patient potentially elevated the morbidity and possibly result in severe loss of visual acuity. Early diagnosis and treatment could reverse this comorbidity and produce a better outcome for affected patients.

Key words: Extended spectrum β-lactamases; orbital cellulitis; pulmonary tuberculosis