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Letter to the Editor
Otic tuberculosis. Case report
Tuberculosis ótica. Descripción de un caso
Roman Carlosa,
Corresponding author
romanchos@hotmail.com

Corresponding author.
, Lorena Porrasa, Rafael Sánchez Sánchezb
a Departamento de Otorrinolaringología, Hospital Universitario Reina Sofía, Córdoba, Spain
b Departamento de Anatomía Patológica, Hospital Universitario Reina Sofía, Córdoba, Spain
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bronchial hyperreactivity&#44; seborrheic dermatitis&#44; lumbar spine osteopenia&#44; a heterozygous prothrombin gene mutation&#44; and a right single lung transplantation with a simultaneous lingulectomy four years ago due to bronchiectasis syndrome&#46; He reported a pre-transplantation colonization by <span class="elsevierStyleItalic">Pseudomonas</span> sp&#46;&#44; <span class="elsevierStyleItalic">S&#46; aureus</span>&#44; and <span class="elsevierStyleItalic">Alcaligenes xylosoxydans</span>&#44; as well as some post-transplantation complications&#44; including an episode of acute transplant rejection&#44; a mixed respiratory tract infection&#44; anemia&#44; arterial hypertension&#44; and sternal osteomyelitis caused by <span class="elsevierStyleItalic">Candida albicans</span>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient consulted with the on-call Emergency Care otorhinolaryngologist due to experiencing chronic ear discharge of several week&#8217;s evolution that responded poorly to topical treatment&#44; together with profound bilateral hearing loss&#46; An otoscopic examination revealed multiple granulomatous lesions in his tympanic membrane&#44; associated with the presence of whitish discharge and inflammation of the external auditory canal of both ears &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Because several sample cultures were performed without detecting a clear underlying cause of his condition&#44; and given the suspected diagnosis of complicated otitis media&#44; a biopsy and a computerized axial tomography &#40;CAT&#41; scan with an intravenous &#40;IV&#41; contrast agent were performed on both ears&#46; The CAT scan images revealed tympanic cavities with soft-tissue occupation resulting in bone alterations&#44; as well as thinning and irregularities in the ear bones&#46; A loss of bilateral pneumatization was also observed&#44; together with predominantly right-sided sclerotic phenomena at the level of the mastoid cells&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The diagnostic studies were completed with a single-photon emission computed tomography &#40;SPECT&#41; scan that revealed pathological contrast uptake levels in both petrous temporal lobes&#44; with the left focus spreading up to the mastoid antrum&#44; as well as a cavitated infiltrate in the right upper lung lobe&#46; Given that the otic exudate culture was negative&#44; a fibrobronchoscopy and bronchoalveolar lavage &#40;BAL&#41; were performed on the anterior segment of the right upper lung lobe&#44; and the collected samples were sent to the Pathology and Microbiology laboratories for testing&#46; Although the BAL cytology study was negative for malignancy&#44; <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> complex of the bovine variant was isolated&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The left ear biopsy performed applying the Ziehl-Neelsen technique was positive for acid-alcohol-fast bacilli &#40;AAFB&#41; compatible with tuberculosis&#46; Based on these findings&#44; treatment with rifampicin&#160;&#43;&#160;isoniazid&#160;&#43;&#160;pyrazinamide&#160;&#43;&#160;ethambutol was started following the patient&#8217;s assessment in the Pulmonology Department&#46; He was finally diagnosed with pulmonary tuberculosis in the context of a right single lung transplantation and secondary otomastoiditis &#40;necrotizing granulomatous otitis&#41;&#44; owing to which he was prescribed a weekly follow-up with ear cleanses for the following two months&#44; observing a lower amount of ear discharge and fewer tympanic granulations&#46; Four months later&#44; persistent central perforations were detected in the posteroinferior quadrants of both ears&#44; without active ear discharge&#46; However&#44; subsequent follow-up audiometry tests revealed that he had developed total anacusis in his right ear and severe sensorineural hearing loss in his left ear&#46; Unfortunately&#44; during his follow-up he developed a complicated pneumococcal lung infection that eventually resulted in his death&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Middle ear tuberculosis is an uncommon disease with non-specific symptoms whose diagnosis is hard to reach&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Its prognosis depends on the time until diagnosis and the time of treatment onset&#44; and its diagnosis is reached based on the results of pathology tests and&#44; complementarily&#44; the levels of C-reactive protein &#40;CRP&#41; in a blood biochemistry analysis and the findings of microbiology tests&#46; Its treatment is fundamentally based on the use of anti-tuberculosis drugs for six to 12 months&#44; with surgery being limited exceptionally to cases with complications such as facial paralysis&#44; abscesses&#44; or meningitis&#46;</p></span>"
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                            3 => "O&#46; Vales"
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                      "titulo" => "The changing epidemiology of tuberculosis in a Spanish tertiary hospital &#40;1995&#8211;2013&#41;"
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Original language: English
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es en pt

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

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