We report two immigrants with
tuberculosis of the skull base and a review of the literature. A Somalian man presented with bilateral
otitis media,
hearing loss, and facial and
abducens palsy. Imaging showed involvement of both mastoid and petrous bones, extending via the skull base to the nasopharynx, suggesting
tuberculosis which was confirmed by characteristic histology and positive
auramine staining, while Ziehl-Neelsen staining and PCR were negative. A Sudanese man presented with
torticollis and deviation of the uvula due to
paresis of N. IX and XI. Imaging showed a
retropharyngeal abscess and lysis of the clivus. Histology,
acid-fast staining, and PCR were negative. Both patients had a positive Quantiferon TB
Gold in-tube result and improved rapidly after empiric treatment for
tuberculosis. Cultures eventually yielded M.
tuberculosis. These unusual cases exemplify the many faces of
tuberculosis and the importance to include
tuberculosis in the differential diagnosis of unexplained problems.