# Diagnostic Dilemma: Tuberculosis Mastoiditis in an Immunocompromised Patient

## TL;DR

This case report discusses the rare and challenging diagnosis of tuberculosis mastoiditis in an immunocompromised patient, emphasizing the importance of proper testing for timely treatment.

## Contribution

The paper highlights diagnostic challenges and the importance of TB testing in non-responsive otitis media cases.

## Key findings

- TB mastoiditis presents with symptoms similar to bacterial ear infections, leading to missed diagnoses.
- CT scans and histopathology are essential for diagnosis, while PCR offers higher sensitivity for TB detection.
- TB should be considered in otitis media cases unresponsive to antibiotics, especially in immunocompromised individuals.

## Abstract

Tuberculosis (TB) is endemic in Malaysia but rarely affects the middle ear cleft. Common presentations of TB mastoiditis include unilateral, painless otorrhea, multiple small perforations of the tympanic membrane, and facial nerve palsy, although these symptoms can vary among patients. The diagnosis of TB mastoiditis is challenging due to its rarity and its similar presentation to common bacterial ear infections. This often leads to missed diagnoses, resulting in significant delays in treatment and potential complications. CT scans and histopathological examinations are crucial for diagnosing TB mastoiditis. Real-time polymerase chain reaction offers higher sensitivity and specificity compared to conventional methods for detecting Mycobacterium tuberculosis. TB infection should be considered in cases of otitis media that do not respond well to empirical antibiotic therapy. It is essential to send appropriate samples for TB testing to ensure timely diagnosis and treatment. This case report highlights the diagnostic challenges and complications encountered in a 22-year-old immunocompromised woman with TB mastoiditis.