TUBERCULOUS OTOMASTOIDITIS IN AN IMMUNOCOMPETENT PATIENT

Disseminated tuberculosis can be defined as the presence of infection by Mycobacterium tuberculosis in two or more noncontiguous organs, often with hematogenous involvement. Its occurrence is associated with immunosuppressed patients and is more prevalent in patients with HIV. We describe a case of tuberculosis with bone, intestinal, and pulmonary involvement in an immunocompetent patient: a 30-year-old man, administrative assistant, living in an urban area in Northeast Brazil. He was admitted to the hospital with a 6-month history of lower abdominal pain, followed in the last 30 days by daily diarrhea. In addition, he reported a 15-kg weight loss over the same period and daily fever. Concurrently, he reported left hearing loss for 5 months and, 3 months earlier, developed painless otorrhea of whitish-yellow color. After one month of progression, he developed the same symptoms in the right ear. CT showed intra-abdominal lymphadenopathy with necrotic centers, with evidence of ileitis, as well as a cavitary lesion in the middle third of the right lung with a perilesional tree-in-bud pattern, and signs of bilateral otomastoiditis complicated by left mastoid erosion and deep cervical abscess formation. Disseminated tuberculosis was confirmed by a detectable molecular rapid test for tuberculosis in a fragment of left mastoid mucosa and in an ileal mucosa fragment. Treatment with rifampicin, isoniazid, ethambutol, and pyrazinamide was started, with excellent clinical and radiological response, although the patient maintained residual left hearing loss. We present a case of disseminated tuberculosis with approximately 6 months of evolution in an immunocompetent patient, with only a history of prior contact with tuberculosis in childhood, without other associated risk factors such as HIV infection and alcoholism. In countries endemic for tuberculosis such as Brazil, early diagnosis is necessary even in patients without respiratory symptoms.