DOI: https://doi.org/10.36347/sjmcr.2026.v14i05.030

Pages: 989-993

Background: Tuberculous mastoiditis is a rare manifestation of extrapulmonary tuberculosis, particularly in the pediatric population. Its clinical presentation may be insidious and atypical, mimicking chronic otitis media or parotid gland pathology, which can significantly delay diagnosis. Case Presentation: We report the case of a 6-year-old child who presented to our otorhinolaryngology department with a fistulized right mastoiditis, a pre-fistulized parotid swelling, and fistulized right laterocervical lymphadenopathy evolving over several months. Biological workup revealed elevated inflammatory markers and a positive tuberculin skin test. Cervicofacial ultrasound demonstrated a heterogeneous collection in the parotid region with adjacent necrotic lymphadenopathy, and magnetic resonance imaging (MRI) of the temporal bone and neck revealed opacification of the right middle ear and external auditory canal with a retroauricular fistulous tract, and multiple necrotic intraparotid and jugulocarotid lymph nodes with skin fistulization. Histopathological examination of a biopsy specimen obtained through the mastoid fistula confirmed the diagnosis of tuberculosis, showing epithelioid granulomas with central caseous necrosis. The patient was referred for standard antitubercular therapy and demonstrated favorable clinical outcome at follow-up. Conclusion: This case highlights the importance of considering tuberculosis in the differential diagnosis of pediatric mastoiditis presenting with parotid and laterocervical lymphadenopathy, even in the absence of classic pulmonary features. Early histopathological analysis through accessible fistulous tracts can expedite diagnosis and avoid unnecessary surgical procedures.