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Diagnosis at first sight
Unusual peripheric facial palsy
Parálisis facial periférica de causa inusual
Sandra Aixuta,b, Giulia Pisanoc, Maria Luisa Aznara, Joan Martínez-Campreciósa,b,
Corresponding author
jmc3689@gmail.com

Corresponding author.
a Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
b Hospital Nossa Senhora da Paz, Cubal, Benguela, Angola
c Department of Pediatrics, La Fe University Hospital, Valencia, Spain
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Additionally&#44; a right peripherical facial palsy could be noticed &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; On chest auscultation&#44; we heard left lung-base crackles&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Evolution</span><p id="par0010" class="elsevierStylePara elsevierViewall">In the chest X-ray&#44; we observed a soft infiltrate in the left base without perihilar or mediastinal masses&#46; Rapid capillary HIV test &#40;Alere Determine HIV 1&#47;2&#44; Abbott&#41; was negative&#46; Molecular testing &#40;Xpert MTB&#47;RIF ultra&#44; Cepheid&#41; of a nasogastric aspirate sample was negative for TB&#44; and later on&#44; positive in a purulent sample taken from the ear&#46; No rifampicin resistance was detected&#46; Under the diagnosis of a peripheric facial palsy caused by a TB otomastoiditis associated to a cervical scrofula&#44; standard four first-line TB treatment was initiated&#46; Due to its absence&#44; and the impossibility of transferring the patient to a tertiary hospital&#44; no other radiological tests could be made&#46; Given the impossibility to perform a surgical facial nerve decompression&#44; corticosteroid treatment was considered but finally rejected due to the poor nutritional status and increased risk of infection&#46; Local right-eye care was recommended&#46; In addition&#44; the patient presented a <span class="elsevierStyleItalic">P&#46; falciparum</span> infection that was treated with an artemisinin-based regimen&#44; received a short course of ceftriaxone for suspected left basal pneumonia as well as nutritional support with therapeutic milk&#46; After two months of follow-up the child was gaining weight&#44; systemic symptoms had disappeared and cervical swelling and facial palsy had improved &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Final comment</span><p id="par0015" class="elsevierStylePara elsevierViewall">Otomastoiditis is a rare form of extrapulmonary TB &#40;0&#46;1&#37; of all cases&#41; accounting for less than 1&#37; of chronic middle ear infections&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> It can occur by aspiration of mucus through the eustachian tube&#44; by direct implantation through the external auditory canal&#44; or as a result of hematogenous spread&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> Otorrhea is the main symptom reported&#46; Although uncommon&#44; the triad of painless otorrhea&#44; multiple perforation of the tympanic membrane and peripheral facial palsy should raise suspicion of TB&#46; Diagnosis is often delayed&#44; especially in regions with a low burden of TB and in cases of chronic isolated non-painful otorrhea&#46; Acid-fast staining&#44; molecular testing and culture from local discharge or biopsy samples can give the diagnosis&#46; Concomitant pulmonary involvement is reported in up to 50&#37; of cases&#46; Local complications such as tympanic perforation&#44; hearing loss&#44; mastoiditis&#44; subperiosteal abscesses or facial paralysis are frequent and can lead to persistent sequelae&#46; Intracranial extension is infrequent&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> Antituberculostatics given for 6&#8211;9 months is the mainstay of treatment&#46; In case of complications&#44; surgical approaches such as mastoidectomy or facial nerve decompression must be considered&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Authors&#8217; contribution</span><p id="par0020" class="elsevierStylePara elsevierViewall">We were all involved in the patient&#39;s care and diagnosis&#46; S&#46;A&#46; and J&#46;M&#46;C&#46; wrote the first draft of the manuscript which was edited and finally approved by G&#46;P&#46;&#44; A&#46;N&#46; and M&#46;L&#46;A&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Informed consent</span><p id="par0025" class="elsevierStylePara elsevierViewall">Written consent for publication was obtained from the patient&#39;s mother&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Financial disclosure</span><p id="par0030" class="elsevierStylePara elsevierViewall">This research received no specific grant from any funding agency in the public&#44; commercial&#44; or non-profit sectors&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflict of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interests&#46;</p></span></span>"
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Article information
ISSN: 0213005X
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos