Tuberculous otitis media masquerading as malignancy: a diagnostic challenge

Abstract Background Primary tuberculous otitis media is rare in the paediatric age group, and its neuro-otogenic complication of involvement of cerebellopontine angle in a child is very unusual. Tuberculosis should always be considered as a rare but possible aetiology for such neuro-otogenic lesions. Case presentation We report a case of a 13-year-old female patient who presented with left ear discharge and mass-like lesion on otoscopy. High-resolution computed tomography (HRCT) temporal bone showed erosion of petrous temporal bone, external auditory canal and ossicles. Contrast-enhanced MRI (CEMRI) revealed peripherally enhancing hetero-intense lesion epicentred in the petrous and mastoid part of left temporal bone extending into the left cerebellopontine angle and external auditory canal. Homogenously enhancing soft tissue was seen in the left occipital condyle with sigmoid sinus thrombosis and cervical lymphadenopathy. There was also a single enhancing left temporal lobe lesion. Radiological and clinical assessment was suggestive of malignant aetiology. However, biopsy revealed tuberculosis and anti-tubercular therapy (ATT) was initiated. Interval imaging showed an adequate response to treatment. Conclusions Tuberculous otitis media often masquerades as malignancy on clinical and imaging assessment.