Unusual presentation of tubercular mastoid cyst

Tuberculosis in the otomastoid compartment is extremely rare. The classical presentation of tuberculous otitis media includes chronic otorrhea, severe hearing loss irrespective of the disease, multiple perforations, and pale granulations in the middle ear cavity. However, most present with non-specific signs and symptoms making it a diagnostic dilemma. Here, we report a case that presented with a bony mastoid cyst which is the first case report to the best of our knowledge. A 12-year-old boy visited our center with a complaint of chronic ear discharge and hearing loss not improving with conventional antibiotic therapy. The computed tomography scan of the temporal bone revealed soft tissue opacification in the mastoid along with features suggestive of cholesteatomatous chronic otitis media. The patient underwent mastoidectomy under general anesthesia, which revealed a bony mastoid cyst filled with turbid fluid along with granulation tissues in the middle ear cleft without cholesteatoma. Final histopathology revealed tuberculous otitis media. Antitubercular chemotherapy was started and the patient’s condition recovered. Primary tuberculous mastoiditis is a rare clinical entity that requires a high index of suspicion. It can also present as chronic otorrhea with mastoid cyst, and thus need to be considered as one of the differential diagnoses.

Tuberculous mastoiditis in a 2-month-old infant presenting with facial nerve palsy

We present a rare case of tuberculous mastoiditis in a 2-month-old infant. The patient presented with facial nerve palsy, fever and otorrhoea and was subsequently confirmed to have a Mycobacterium tuberculosis infection. Mastoiditis was confirmed with a CT scan of the head, and gastric aspirate analysis with the Xpert MTB/RIF assay (Cepheid, USA) rapidly confirmed tuberculosis (TB), allowing prompt initiation of anti-TB therapy. The patient is now recovering, with the initial facial nerve palsy resolved.

ACQUIRED ENCEPHALOCELE ATTRIBUTABLE TO TUBERCULOUS OSTEITIS

OBJECTIVE There are many forms of calvarial tuberculosis. In this case report, extensive calvarial tuberculosis caused a large cranial defect and occlusion of the sigmoid sinus in a 10-year-old child. This resulted in a transient increase of the intracranial pressure and formation of an acquired encephalocele. CLINICAL PRESENTATION A 10-year-old boy presented with an acquired, infected encephalocele and features of tuberculous mastoiditis. Computed tomographic and magnetic resonance imaging scans demonstrated evidence of left occipital encephalocele with left mastoiditis, extradural granulations, bone destruction, and complete occlusion of the left sigmoid sinus. INTERVENTION The encephalocele was surgically excised and combined with left mastoidectomy. Although no mycobacterium had been demonstrated in the excised lesion, the presence of active tuberculous infection in the mastoid led to the conclusion that the bone destruction leading to encephalocele was secondary to the calvarial tuberculosis. The patient received antituberculous treatment with clinical improvement. CONCLUSION This is the first report of calvarial tuberculosis causing a cranial defect and venous sinus thrombosis and resulting in an acquired encephalocele. Surgical excision combined with medical treatment was curative.