|Year : 1978 | Volume
| Issue : 1 | Page : 54-56
Koch's cutis: (A case report)
Bhushan V Shukla, KJ Sheth
Department of Ophthalmology, Medical College and S.S.G. Hospital, Baroda, India
Bhushan V Shukla
Department of Ophthalmology, K.J. Seth, Eye Dept . Medical College and S.S.G. Hospital, Baroda
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Shukla BV, Sheth K J. Koch's cutis: (A case report). Indian J Ophthalmol 1978;26:54-6
While pulmonary tuberculosis is very common in India, involvement of the skin is an uncommon manifestation of the disease, affection of the eyelid alone is still rarer. A study of the current literature on tuberculosis contains very few accounts of skin tuberculosis primarily affecting the eyelid. The present case report is one more addition to this rare entity.
| Case history|| |
A young man, S.L. aged 30 years presented with a gradually increasing, almost painless ulcer on the right upper eyelid for a period of 9 months. The patient had taken some indigenous treatment but without any relief. There was a positive history of sexual exposure one year back.
On examination, an irregular, shallow ulcer was found involving the whole of right upper lid, including lid margin. Its edge was raised base indurated, floor dry and covered with multiple, small warthy nodules [Figure - 1].
Eyeball and palpebral conjunctiva were normal.
Right pre-auricular lymph node was slightly enlarged.
Systemic examination was negative.
Investigations: All investigating were negative.
Histopathology: A small piece of the ulcer was excised and examined histopathologically, It revealed typical tuberculous granuloma, with giant cells and lymphocytes, but caseation was absent [Figure - 1],[Figure - 2].
Treatment: The patient was put on anti Koch's treatment with inj. streptomycin 0.75 gins. on alternate days for 2 months. In addition tab. INH 300 mg daily and tab PAS 8.0 gm daily were also given. After 2 months of treatment the ulcer has practically healed [Figure - 3].
| Discussion|| |
The eyelid may be implicated in tuberculosis as a part of the involvement of the skin of the face due to local progression. In such a case it can properly be termed lupus vulgaris. The primary affection of the skin of the eye lid only is a rarity and difficult to explain. Such cases have been described earlier by Braunschweig, V. Michel Friedenwald, Salvati, Stewart, Wilson, Higab and others. The incidence of primary lid affection could be about 1 in 100 cases of skin tuberculosis (2 in 374 cases, Bender; 4 in 137, Sachs; 2 in 121, Block).
The mode of infection may be either due to direct inoculation or a spread from a local or a systemic focus. In the latter event, this focus may lie either in the palpebral conjunctiva or in the nasal mucosa, in which case, infection spreads to the eyelid by a retrograde route through the lacrimal passage from nasal cavity. A haematogenous spread can also occur but in that even the lid involvement would not be isolated and would form a part of the generalized spread (military tuberculosis).
In over 40% of cases, the infection is of bovine type. The type of the clinical form depends partly on the mode of the infection and partly on the conditions of immunity and allergy of the skin itself. The disease usually starts as a small nodule under the epithelium, which if occurring near the lid margin, may resemble a stye or a chalazion. The nodule ulcerates after some time and spreads locally in an irregular fashion, often accompanied by pain and mucoid or at times purulent discharged. Secondary infection with pyogenic organisms may occur. Multiple nodules appear in the floor as well as at the margin of the ulcer. Frequently, as the ulcer spreads, some attempt occurs at healing in the centre. The disease is very insidious, and if untreated, involves both the eyelids, and the resultant lid complications like ectropion endanger the eye itself.
The diagnosis is usually easy in typical form to the enlightened, but may require biopsy for establishing the diagnosis. In younger patients, it may be confused with syphilis, while in older patients it may resemble malignancy.
With effective systemic anti-tubercular therapy, the once difficult to cure disease has become eminently curable. A full systemic course is necessary for complete cure and prevention of recurrence. The lid complications require surgery.
| Summary|| |
A case of primary tuberculosis of eyelid has been described and efficacy of anti-tubercular drugs has been demonstrated in treating this condition.
| References|| |
Braunschweig, 1892, Munch, Med. W., XXXIX, 371.
Frieden aid, 1913, Amer. J. Ophrhal, XXX, 65.
Higab, 1939, Bull. O.S. Egypt, XXXII, 65.
Michel V., 1908. G.S. lib. II, V(2), 95,
Salvati, 1923, An. d'Oc, CIX, 810.
Stew art, 1935, Trns of Ophthal Soc, LV, 540.
Wilson. 1936, Rep. Mem. O. Lab. Giza, XI, 70.
[Figure - 1], [Figure - 2], [Figure - 3]