Tinnitus revealing a multifocal tuberculosis: a case study

Abstract Introduction Tuberculosis is a major public health problem in Morocco; its clinical presentation can be misleading, particularly when the initial symptoms are neurological or sensory. Observation We report the case of a 32-year-old diabetic patient with no known history of tuberculosis who consulted for isolated, persistent tinnitus that had been developing for three months, with no associated respiratory signs. The initial ENT examination was unremarkable. The course of the disease was marked by the onset of left hypoacusis and paresthesia of the left side of the face and upper limb, accompanied by nocturnal fever and deterioration of the patient’s general condition. A brain MRI revealed a left otomastoid abscess associated with necrotic thalamic and mesencephalic brain lesions suggestive of tuberculomas. A chest, abdominal, and pelvic CT scan revealed diffuse pulmonary miliary tuberculosis with mediastinal lymphadenopathy and adrenal enlargement. The GeneXpert MTB/RIF test on sputum was positive, confirming infection with Mycobacterium tuberculosis . A diagnosis of multifocal tuberculosis affecting the lungs, nervous system, ENT and adrenal glands was made. Four-drug antituberculosis therapy was initiated, with favorable clinical progress. Discussion Tinnitus is an unusual manifestation of disseminated tuberculosis. There are rare reports of auditory manifestations in tuberculosis of the central nervous system or middle ear, but no cases have described persistent isolated tinnitus as the initial symptom of multifocal tuberculosis. This presentation highlights the clinical polymorphism of the disease and the resulting diagnostic difficulties. Conclusion In cases of unexplained persistent tinnitus, particularly in areas where tuberculosis is endemic, a systemic infectious etiology should be considered. Molecular biology plays a central role in early diagnosis, enabling rapid treatment and improved prognosis.