This is a 15-month-old infant with no recent tuberculosis infection, who presented for a 3-month-old symptomatology of left ear otalgia. A month later, the symptomatology was complicated by the appearance of a left retro-auricular swelling gradually increasing in volume, as well as wheezing dyspnea associated with a dry cough at night and during the day. All evolving in a context of unencrypted fever and alteration of the general condition made of anorexia, and weight loss of 3 kilos over 1 month. The patient was put on antibiotic treatment twice but without any improvement. This motivated the parents to consult with an otorhinolaryngologist doctor who performed an ultrasound of the swelling having shown a left retro atrial cystic formation measuring 18 x 12 mm rather well limited to thin walls, with finely echogenic content, with next bone cortical continuity solution. A mass puncture was made bringing back 5CC of purulent and hematic fluid whose cytobacteriological study was negative, but the gene Xpert on the puncture fluid showed the presence of Mycobacterium tuberculosis. The patient was referred to us for treatment.
The interrogation was repeated and objectified the notion of administration of unpasteurized goat's milk 6 months ago.
Clinical examination objectified a hemodynamic and respiratory stable infant, apyretic at 36.9 C, eupneic at 37 cc/min, and Normocard at 99 bat/min.
Its weight was 10 kg (-3DS) and its height was 74 cm (-3DS).
The ENT examination objectified a soft retro atrial swelling, painful to palpation measuring 4 cm without inflammatory signs in front (Fig. 1). The remainder of the review was nonspecific.
A chest X-ray indicated a deviation of the trachea with bilateral chest distension (Fig. 2).
A CT scan of the petrous bone showed an appearance in favor of an aggressive left otomastoiditis (bone lysis) (Fig. 3) complicated neighborhood collection with homolateral sigmoid sinus thrombosis (Fig. 4).
The patient was put on antituberculosis treatment, 2RHZE/10RH because of the bone lysis with anticoagulant treatment low molecular weight heparin:100 IU/kg/12 h and antivitamin K: 0.2 mg/kg/jr with INR monitoring each week.
The evolution was satisfied by the regression of the retro-auricular swelling as well as the disappearance of the otalgia and the swelling with a weight gain and recovery of the appetite.