Tuberculous otomastoiditis in children complicated by homolateral sigmoid sinus thrombosis: a case report

Tuberculosis is a major public health problem in Morocco and most of the developing countries but tuberculous otomastoiditis is quite rare. Here we report a case where a seven-year-old patient had chronic right otomastoiditis and retro-auricular fistula, whose specificity is its persistence after prolonged unsuccessful medical and surgical therapy for more than 2 months, and its complication by homolateral sigmoid sinus thrombosis. Computed Tomography (CT) scan of temporal bones showed complete destruction of right mastoid cells and a hypodense complement in the right middle ear. A right drainage through the retro auricular fistula with mastoid bone biopsy confirmed the tuberculous otomastoiditis diagnosis. The clinical and radiological outcome was favorable after anti-tuberculosis treatment for 6 months. Tuberculosis otomastoiditis is well described in the literature. However, its very low incidence often impedes consideration when faced with these latent infections. This is more so the case when concomitant pulmonary symptoms are absent. Thus, the importance of such publications is a reminder to think beyond the frequent diagnosis and prevent serious complications due to delayed treatment.