Multifocal disseminated otomastoid tuberculosis in an immunocompetent adult from an endemic area

Cámara-Reyes R.R.; Agurto-Lescano E.C. · Revista Cubana de Medicina Militar (2026)

Resumen

Background: Otic tuberculosis is an exceptional extrapulmonary manifestation; its concomitant presentation with intestinal and perianal involvement in immunocompetent patients is extraordinarily rare. Objective: To report a case of multifocal otomastoid tuberculosis in an immunocompetent adult. Case Report: A 45-year-old male from a tuberculosis endemic area (Peru) with chronic otorrhea and perianal fistulas presented with mastoiditis. Evaluation revealed disseminated tuberculosis with otomastoid, pulmonary, intestinal, and prostatic involvement. Diagnosis was confirmed by smear microscopy and GeneXpert MTB/RIF in otic secretion (rifampicin susceptible). Imaging showed mastoid occupation with bone erosion, complex perianal fistulas, and a prostatic abscess. The patient received first-line antituberculous treatment with a favorable outcome. Conclusions: A high suspicion of tuberculosis should be maintained in the presence of refractory chronic otorrhea; even in immunocompetent patients, it may be the first sign of systemic disease. Molecular testing of otic secretions allows rapid diagnosis and avoids invasive procedures.