Primary tuberculous petrositis

Abstract

Tuberculous osteomyelitis of the temporal bone is a rare and dangerous entity that should be included in the differential diagnosis of infectious processes of the base of the skull. We present the case of an 11-year-old child who presented with diplopia, ear discharge and hearing loss. The radiological and histopathological findings revealed tuberculous otitis with osteomyelitis and an abscess in the petrous apex. The child responded to anti-tuberculous chemotherapy. The diagnosis and management of tuberculous osteomyelitis are discussed and a brief review of the literature is presented.

Tuberculous Otitis Media, Petrous Apicitis, Brain Abscess And Meningoencephalitis in A 16-Month-Old Child

“…Most cases are attributable to purulent infection, and a few cases of tuberculous petrous apicitis have been described. The latter are mostly due to complicated pulmonary tuberculosis and are rarely primary [8]. The petrous apex is anatomically closely related to the eye branches of the trigeminal nerve and n.abducens.…”

Gradenigo Syndrome Caused by Nontuberculous Mycobacteria

“…Pus swab culturing or acid-fast staining of the otorrhea has low sensitivity ( ≤ 20%) for the diagnosis of otological tubercular infections [Sethi et al, 2005]. Pus cultures of ear 281 discharge may also have limited diagnostic utility for otological NTM infections.…”

“…Most oto- logical NTM infections result from inoculation due to trauma, surgery, or an injection [van Aarem et al, 1998]. Other possible sources of such an infection include exposure to contaminated water and transmission via the eustachian tube [Flint et al, 1999;Moerman et al, 1993;Sethi et al, 2005;TerKonda et al, 1995]. No evidence of human-to-human or animal-to-human transmission exists [Flint et al, 1999;Griffith et al, 2007;Medjahed et al, 2010;Muller et al, 2006;Redaelli de Zinis et al, 2003;Sugimoto et al, 2010;TerKonda et al, 1995].…”

“…The incidence of petrous apicitis has decreased markedly since the 1940s due to the advent of antibiotics. The widespread use of antibiotics has also altered the clinical picture by masking the symptoms [Gradenigo, 1907;Lee et al, 2005;Price and Fayad, 2002;Sethi et al, 2005;Sherman and Buchanan, 2004;van Aarem et al, 1998]. The majority of Gradenigo cases were caused by pyogenic bacteria, including Staphylococcus aureus and Pseudomonas aeruginosa [Sherman and Buchanan, 2004].…”

“…The majority of Gradenigo cases were caused by pyogenic bacteria, including Staphylococcus aureus and Pseudomonas aeruginosa [Sherman and Buchanan, 2004]. The uncommon patho-gens included Mycobacterium tuberculosis [Sethi et al, 2005].…”