# Orbital tuberculosis mimicking a vascular emergency: A case report of superior ophthalmic vein engorgement

## TL;DR

A rare case of orbital tuberculosis was mistaken for a vascular emergency, highlighting the importance of considering TB in similar presentations.

## Contribution

This case report highlights the rare presentation of orbital tuberculosis mimicking vascular emergencies.

## Key findings

- Orbital tuberculosis can present with superior ophthalmic vein engorgement resembling vascular emergencies.
- Diagnosis was confirmed through Ziehl–Neelsen staining and PCR for Mycobacterium tuberculosis.
- Anti-tuberculosis treatment led to recovery after two months.

## Abstract

We report a rare case of orbital tuberculosis (O-TB) in an elderly diabetic patient that mimicked a variety of vascular, infectious, and inflammatory orbital diseases. A 73-year-old woman with uncontrolled diabetes, unilateral swelling of the left eye, proptosis, and binocular diplopia, as well as left superior ophthalmic vein (SOV) engorgement on an orbital CT scan, was referred to our center to rule out a carotid-cavernous fistula (CCF) or a cavernous sinus thrombosis (CST). An MRI, MRV, and cerebral angiography ruled out both diagnoses. Nasal endoscopy revealed septal necrosis, and biopsy demonstrated infectious necrosis. Initial bacterial and fungal smear and cultures were negative. However, Ziehl–Neelsen staining and culture on Lowenstein–Jensen medium were positive for acid-fast bacilli, and PCR confirmed Mycobacterium tuberculosis. The patient was treated with anti-tuberculosis treatment and recovered two months after treatment. O-TB may rarely mimic a vascular emergency through isolated superior ophthalmic vein engorgement. Clinicians should specifically consider orbital tuberculosis in patients with orbital inflammation and vascular-mimicking imaging findings when routine vascular evaluations are inconclusive, particularly in tuberculosis-endemic regions, to avoid diagnostic delay and ensure timely and appropriate treatment.