Bilateral otitis media as an initial manifestation of disseminated tuberculosis disease in a patient with late HIV infection diagnosis

Tuberculous otitis media is a rare form of extrapulmonary tuberculosis, often resulting in delayed diagnosis due to its nonspecific symptoms and low clinical suspicion. We present the case of a 29-year-old woman with initial symptoms of sudden speech impairment without other neurological manifestations. In the previous 3 months, the patient had consulted several times to the health care system due to bilateral otitis media, which did not improve with conventional treatments. Daily fever, diarrhea and weight loss were added to the picture. After admission to the Infectious Diseases department, she was diagnosed with advanced HIV infection and disseminated tuberculosis (TB) with pulmonary, intestinal, lymph node and otic involvement. This case underlines the complexity of diagnosing TB otitis media, especially in the context of HIV co-infection, and highlights the importance of routine HIV screening in patients with persistent, unexplained symptoms to facilitate early diagnosis and prevent complications.