# Case Report: NGS-guided rapid diagnosis of tuberculous otitis media—a rare case of dual-site Mycobacterium tuberculosis infection

## TL;DR

A young man's hearing loss led to the rapid diagnosis of tuberculosis in both his lungs and ears using genetic sequencing.

## Contribution

This case demonstrates the use of NGS for rapid, resistance-guided diagnosis of dual-site tuberculosis.

## Key findings

- NGS identified Mycobacterium tuberculosis in both pulmonary and middle-ear fluid samples.
- The rpsL K43R mutation indicated streptomycin resistance in both infections.
- Standard treatment led to rapid clinical improvement and reduction in pulmonary cavity size.

## Abstract

Tuberculous otitis media (TOM) is an exceptionally rare form of extrapulmonary tuberculosis that was usually diagnosed only after long-standing ear discharge or profound hearing loss. This case reported a young man in whom deafness was the sentinel event leading to the discovery of pulmonary tuberculosis and molecular confirmation of concurrent TOM.

A 23-year-old male presented with bilateral, progressive hearing loss that had been labeled “chronic suppurative otitis media” by local clinics. Persistent constitutional symptoms prompted chest imaging that revealed bilateral cavitary infiltrates. Broncho-alveolar lavage metagenomic next-generation sequencing identified Mycobacterium tuberculosis complex (MTBC). After transfer to our tuberculosis center, targeted NGS of serous middle-ear fluid detected MTBC; the isolate carried an rpsL K43R mutation conferring streptomycin resistance, identical to the pulmonary strain. Standard four-drug anti-tuberculosis therapy was initiated; within 4 weeks, cough and fever resolved, inflammatory markers normalized, and the pulmonary cavity showed reduction in size compared to baseline.

This case highlights that unexplained hearing loss may serve as an early indicator of disseminated tuberculosis. High-throughput sequencing of aural discharge enables rapid diagnosis of TOM, facilitates resistance-guided treatment, and helps trace the pathways of pathogen transmission.