A woman was diagnosed with a latent tuberculosis infection for almost 50 years, which had migrated to the ear. A relatively rare occurrence sometimes called “turkey ear.”
A woman in her fifties with a blistered ear and leaking a liquidliquid with the foul odor presented itself recently to the Beilinson Medical Center, in Petah Tikva, Israel. The patient explains that she has had an ear lesion since her childhood, but over the years it has degenerated: the ear has become yellowish-brown, edematous, with a consistency and colorcolor similar to that of “cooked apple jelly”, relate the doctors who described his case in the journal JAMA Dermatology. Recently, a foul-smelling liquid started leaking from his ear.
A “turkey ear” skin tuberculosis infection
Routine examinations (blood ionogram, liver test, etc.) are normal, but the biopsy reveals the presence of the bacillus. Mycobacterium tuberculosis. In other words, the patient suffers from a rare form of cutaneous tuberculosis or tuberculous lupus, sometimes called “turkey ear” in reference to the texturetexture from the animal’s neck. It is indeed possible that tuberculosis infection manifests itself as a skin condition, but this is relatively rare: between 0.14% and 5% of cases, according to a previous 2016 study published in the Annals of Dermatology and Venereology. Skin damage generally results from contamination endogenousendogenousthat is to say secondary to dissemination bacillarybacillary via blood or lymph from a deep source, particularly pulmonary. It is also possible to become infected through an ear piercing or trauma.
A slow evolution that can last 70 years!
Tuberculous lupus often progresses very slowly: almost 50 years in the case of the Israeli patient. In 1991, doctors even dealt with an 82-year-old man whose infection dated back 71 years earlier! But because the disease progresses chronically and silently, it often takes years to be diagnosed, especially since the level of bacteriabacteria is often undetectable in traditional analyses. Tuberculous lupus, more often located in the neck or around the nosenoseis favored by an immunocompromised terrain or a sensitivity to tuberculin (a substance extracted from cultures of bacillibacilli tuberculosis and used for diagnosticdiagnostic tuberculosis). When it reaches the ear, it manifests itself as gelatinous and granular nodules to the touch, purplish erythematous plaques turning orange-yellow, or tumorstumors soft at the earlobe.
Rare tuberculosis infections
Fortunately, even after decades of infection, TB lupus is fairly treatable. The patient still had to be treated with four treatments antibioticsantibiotics different drugs for two months, reduced to two drugs (rifampicin and isoniazid) for the following seven months. His ear has regained an almost normal appearance (see photo above), with a slight scarscar at the level of the lobe. Other cases described in the scientific literature all report a very favorable outcome with antibiotics.
“ Although tuberculosis has become relatively rare in recent decades, immigration from countries where the disease is endemicendemic could lead to a resurgence in other regions of the world », warn Israeli doctors, who encourage their colleagues dermatologistsdermatologists to suspect tuberculosis in case of “turkey ear”.
