DeSimone Daniel C, Heaton Philip R, Neff Brian A, Dao Linda N, Wengenack Nancy L, Fadel Hind J
Division of Infectious Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN, United States.
Department of Pathology and Laboratory Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, United States.
J Clin Tuberc Other Mycobact Dis. 2017 May 16;8:13-15. doi: 10.1016/j.jctube.2017.05.001. eCollection 2017 Aug.
Chronic otitis externa due to complex is extremely rare and very few cases have been presented in the medical literature. We report here the case of an immunocompetent 68-year-old male with chronic auricular drainage, otalgia, hearing loss, external ear canal and tympanic membrane thickening for 3 years who was ultimately diagnosed with tuberculous chronic otitis externa on biopsy of external auditory canal granulation tissue using molecular diagnostic techniques. Later, sputum cultures were positive for complex indicating disseminated tuberculosis. However, two plausible explanations could be pulmonary TB that disseminated to the ear canal with evidence of middle and outer otitis, or upper airway/nasopharyngeal involvement with direct extension into the middle and outer ear canals. Although extremely rare, extrapulmonary laryngeal head and neck tuberculosis should be considered in immunocompetent patients who present with chronic otitis without prior known exposure to tuberculosis when they fail standard therapy and in whom no other microbiologic cause can be identified.
由复合体引起的慢性外耳道炎极为罕见，医学文献中报道的病例很少。我们在此报告一例免疫功能正常的68岁男性，有慢性耳漏、耳痛、听力损失、外耳道和鼓膜增厚3年，最终通过分子诊断技术对外耳道肉芽组织活检确诊为结核性慢性外耳道炎。后来，痰培养复合体呈阳性，提示播散性结核病。然而，有两种合理的解释：一是肺结核播散至耳道，伴有中耳和外耳炎的证据；二是上呼吸道/鼻咽部受累并直接蔓延至中耳和外耳道。尽管极为罕见，但对于免疫功能正常、患有慢性中耳炎且既往无已知结核接触史、标准治疗无效且无法确定其他微生物病因的患者，应考虑肺外喉头颈结核。
