Tuberculous otomastoiditis complicated by sinus vein thrombosis

Tuberculosis (TB) is a rare cause of chronic suppurative otitis media and mastoiditis, therefore it is usually not considered in the differential diagnosis of chronic infections of this area, especially when evidence of pulmonary tuberculosis is absent.1 This diagnosis should be considered in patients that do not respond to empirical therapy. An 11-year-old previously healthy male was admitted to our hospital with swelling in the mastoid area. Left ear discharge and otalgia had started two months prior. Empirical antibiotic therapy had been prescribed by a pediatrician. Symptoms had persisted despite appropriate antibacterial treatment. Temporal MRI revealed inflammatory swelling in the leftmiddle ear and themastoid air cells (Fig. 1). The patient was treated with surgery, metronidazole, and cefazolin. The pathological specimen showed granulomatous tissue with necrosis and Langhans giant cells. Acid-resistant bacilli was positive in the tissue. The patient’s history was reviewed. His grandfather had received treatment for tuberculosis one year prior, thus our patient had taken prophylaxis, but for an inadequate period and improperly. The 48-hour tuberculin test (PPD) measured 21mm (positive), one BCG scar was observed, and the chest X-ray was normal. Acid-resistant bacilli was