A CASE OF TUBERCULOUS OTITIS MEDIA IN INFANCY -- MANAGAMENT AND SEQUELAE.

Introduction. Tuberculous otitis media (TOM) occurs rarely, and associated symptoms are non-specific therefore making the diagnosis challenging. Delayed or inappropriate therapy, or even with timely and effective therapeutic measures, TOM can lead to serious complications and long-term sequelae, such as hearing loss. Case description. A 3-month-old boy presented to the Childrens' Hospital in Riga, Latvia with complaints of purulent, haemorrhagic discharge from the left ear that initiated a month earlier and showed no improvement after empiric antibacterial therapy with Amoxicillinum. The child was born at 40 weeks gestation, the mother had been diagnosed with human immunodeficiency virus (HIV). Due to unknown HIV status, vaccination was delayed. After failed treatment with Ceforuxime, the symptoms persisted and computed tomography (CT) scan of the temporal bone was performed with suspected findings of congenital lithic tumour of the temporal bone. To investigate further, magnetic resonance imaging was performed with findings suggesting rhabdomyosarcoma and intracranial advancement. Biopsy was obtained from mastoid, posterior ear canal and retro-aural lymph nodes and revealed caseous necrosis masses in all samples thus leading to confirmation of diagnosis of TOM. Milliary tuberculosis of the lungs was also found. Although remission of tuberculosis was achieved, the patient had to undergo several surgical interventions because of fibromatous changes of the temporal bone directly caused by tuberculosis and lymphadenopathy and has received a hearing aid due to mixed type hearing loss in the affected ear at 9 years of age. Conclusions. Awareness of uncommon clinical manifestations in paediatric patients at risk of tuberculosis is crucial for specialists to successfully diagnose and treat the disease and minimize the risk of complications especially in regions endemic of tuberculosis. [ABSTRACT FROM AUTHOR]