Concurrent Middle Ear and Vertebral Tuberculosis Secondary to Mycobacterium Africanum in an Immunocompetent Young Adult in a Low-Incidence Setting: Diagnostic Value of Middle Ear Biopsy

Otic tuberculosis is an exceedingly rare manifestation of extrapulmonary tuberculosis (EPTB) and typically mimics more common otologic conditions, leading to delayed diagnosis and treatment. This report discusses a case of middle ear tuberculosis in a New York City-born-and-raised young woman. She presented with ear drainage, hearing loss, generalized weakness, and a painful lump on her posterior neck. She was subsequently diagnosed with multiple abscesses along the cervical and thoracic spine and a large mass in her middle ear that protruded through her tympanic membrane into the external auditory canal. Biopsy of the protruding part of the ear mass revealed non-necrotizing granulomatous inflammation and acid-fast bacilli on pathology. Mycobacterium tuberculosis (MTB) complex PCR was positive, and mycobacterial cultures grew Mycobacterium africanum. She was promptly initiated on rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE) with clinical improvement of her symptoms.