Not All ENT Granulomas Are Wegener’s – Keep Tuberculosis in Mind

  • Bárbara Pedro Clinical Immunology Unit, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal; Department of Internal Medicine, Hospital Professor Doutor Fernando Fonseca, Lisbon, Portugal
  • Marta Meleiro Clinical Immunology Unit, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal; Department of Internal Medicine, Unidade Hospitalar de Chaves, Centro Hospitalar de Trás-os-Montes e Alto Douro, Chaves, Portugal
  • António Marinho Clinical Immunology Unit, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal

Keywords

Tuberculosis, immunosuppression, mastoiditis, biopsy

Abstract

Mycobacterium tuberculosis affects the middle ear in rare cases and is a challenging diagnosis. In this case, we present a 57-year-old patient diagnosed with anti-neutrophil cytoplasmic antibody (ANCA)-negative granulomatosis with polyangiitis (GPA) following a biopsy result of nasal granulomas, who was immediately started on immunosuppressive treatment. Years later, she developed progressive hypoacusis. Magnetic resonance imaging (MRI) revealed an extensive mass in the tympanic cavity extending to the mastoid. A biopsy of the mass was positive for Mycobacterium tuberculosis. Immunosuppressants were weaned and the patient was started on anti-tuberculous therapy with resolution of the complaints and findings. Tuberculous infections are difficult to diagnose and frequently mimic other illnesses, but in our case, we believe that an indolent tuberculous process was present from the beginning and evolved under immunosuppressive therapy.

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References

  • Bruschini L, Ciabotti A, Berrettini S. Chronic tuberculous otomastoiditis: a case report. J Int Adv Otol 2016;12(2):219–221.

  • Tang IP, Prepageran N, Ong CA, Puraviappan P. Diagnostic challenges in tuberculous otitis media. J Laryngol Otol 2010;124(8):913–915.
  • Published: 2020-02-19

    Issue: Vol 7 No 3 (view)

    Section: Articles

    How to cite:
    1.
    Pedro B, Meleiro M, Marinho A. Not All ENT Granulomas Are Wegener’s – Keep Tuberculosis in Mind. EJCRIM [Internet]. 2020Feb.19 [cited 2020Sep.18];7(3). Available from: https://ejcrim.com/index.php/EJCRIM/article/view/1469