Medicine occasionally uncovers astonishing clinical cases. This one involves a woman in her 50s with decades-long latent tuberculosis that migrated to her ear, giving it an extraordinary texture and hue.
Physicians encounter striking and unusual cases. Notable examples include a woman pregnant with four children in two separate uterine cavities or a man requiring surgery for a fish lodged in his rectum. Experts from Beilinson Medical Center in Israel detailed another remarkable instance in JAMA Dermatology on March 3, 2021.
The patient reported an ear injury from childhood, but over time, her ear's appearance deteriorated dramatically. It developed a mustard-like color and the consistency of "cooked apple jelly." Clinicians noted foul-smelling discharge and significant edematous swelling.
Initial tests were unremarkable, but biopsy confirmed Mycobacterium tuberculosis—Koch's bacillus, the culprit behind tuberculosis. The team diagnosed a rare form of tuberculous lupus, known as "turkey ear." While TB can stem from cutaneous sources, it's uncommon, affecting 0.14% to 5% of cases per a 2016 study.
This skin involvement typically arises from endogenous spread, such as bacillary dissemination via blood or lymph from a primary site like the lungs. Trauma, like piercings, can also trigger it. The condition advances insidiously over years or decades, delaying diagnosis—as in this case.
Tuberculous lupus more commonly affects the nose or face but can involve the ear, forming gelatinous, gritty nodules or erythematous plaques with a distinctive hue, sometimes with soft lobular tumors. Thankfully, it's treatable. The patient received multiple antibiotic regimens over nearly a year, restoring her ear to normal.
