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How did this patient's ear turn into "cooked apple jelly"?

From time to time, medicine reports very surprising clinical cases. This time, it is about a patient in her fifties who has been suffering from a latent tuberculosis infection for decades. The infection migrated to his ear which ended up having an unusual texture and color.

A rare form of tuberculous lupus

Doctors sometimes see rather disturbing cases . Let us quote that of a patient who was pregnant with four children in two different wombs or that of a man who underwent surgery because of the presence of a fish in his rectum. Doctors from Beilinson Medical Center (Israel) described another very surprising case in a publication in the journal JAMA Dermatology on March 3, 2021.

According to the team, a woman in her 50s said she had had an ear injury since childhood. However, the appearance of his ear has totally degenerated over time . The latter turned mustard-colored and took on the consistency of "cooked apple jelly". During the care of the patient, the doctors also observed the discharge of a foul-smelling liquid from this ear. It had swollen like an oedema.

Routine examinations were normal, but biopsy revealed the presence of Mycobacterium tuberculosis . This is Koch's Bacillus , responsible for tuberculosis. According to the doctors, the patient had a rare form of tuberculous lupus nicknamed "turkey ear". Let's talk about the fact that it is possible that TB infection occursas a result of a skin condition . However, it is rather rare. According to a study published in 2016, this indeed concerns 0.14% to 5% of cases.

How did this patient s ear turn into  cooked apple jelly ?

A rather long processing

This type of skin damage usually occurs after a endogenous contamination . In other words, it is possibly a question of an infection secondary to bacillary dissemination. This dissemination takes place from blood (or lymph) coming from a deep source, for example the lungs. It is also possible that such an infection occurs following the placement of a piercing or other trauma to the ear. The disease progresses silently, slowly and chronically. The diagnosis thus often arrives after several years, even several decades as for this Israeli patient.

Found more often in the neck or nose, tuberculous lupus can migrate to the ear. It then takes the form of gelatinous nodules and gritty to the touch or erythematous plaques with an unsavory color. There may also be soft tumors in the lobe. Fortunately for those affected, tuberculous lupus can be treated effectively. The patient still underwent several antibiotic treatments for almost a year before finding a normal ear.