SESSION TITLE: Monday Fellow Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Tuberculosis is a well-known disease process with a very broad clinical presentation which often results in missed or delay in diagnosis. Extra pulmonary tuberculosis accounts for approximately 20% of Tb cases; often having a non-respiratory initial presentation. Therefore, it is prudent that all healthcare providers have a high index of suspicion for tuberculosis in the appropriate clinical setting. CASE PRESENTATION: A 28-year-old Mexican male with history of polysubstance abuse, prior incarceration presented with a two year history of left ear otorrhea, otalgia, tinnitus and cough. Admission vital signs were unremarkable. Physical exam was notable for a well appearing, young male, with left ear showing purulent drainage and exam consistent with conductive hearing loss. Laboratory studies were unremarkable except for mild transaminitis. HIV testing was negative. Patient was evaluated by ENT service and CT head/ temporal bone was ordered. Findings were significant for opacification of left mastoid and middle ear cavity with concern for possible cholesteatoma. Patient underwent left tympanomastoidectomy and cartilage graft with tissue sent for pathology and culture. Pathology was consistent with fibrovascular tissue with necrotizing granulomatous inflammation with numerous AFB positive organisms. Patient was referred to the Infectious Disease clinic, where he complained of generalized weakness, night sweats, and weight loss. CXR and CT chest had findings consistent with pulmonary Tb. Patient was admitted under medicine with respiratory isolation. Induced sputum was positive for acid fast bacilli. Patient was started on rifampin 7.5mg/kg daily, Isoniazid 3.75mg/kg daily, pyrazinamide 20-25mg/kg daily, ethambutol 15mg/kg daily, and vitamin b6 50mg daily with subsequent sputum samples resulting negative for acid fast bacilli. DISCUSSION: Head and neck tuberculosis makes up approximately 2-6% of extra pulmonary Tb and 0.1-1% of all forms of tuberculosis. Otic tuberculosis is a very rare sequela of systemic tuberculosis infection caused by hematogenous or nasopharyngeal spread. Treatment is often prolonged, of up to 6-12 months due to recurrent otorrhea and secondary infection. Sequelae include facial palsy and permanent hearing loss. CONCLUSIONS: Extra pulmonary tuberculosis is an important entity to consider when treating patients with risk factors for Tb without the classic clinical presentation of pulmonary tuberculosis. Once the diagnosis of extra pulmonary Tb is made, it is prudent to assess for lung involvement. This is done in an effort to not only provide the patient with the best care, but to discover any other potential exposures. It is important that all clinicians, including sub-specialists should consider the various extra pulmonary manifestations of tuberculosis in the appropriate clinical setting. Reference #1: Kirsch,CM et.al South Med J. 1995 mar; 88(3):363-6. Reference #2: Lee,JY, Tuberc Respir Dis(Seoul) 2015 Apr; 78 (2):47-55. Reference #3: DeSimone,DC et.al J Clin Tuberc and Mycobact Dis. 2017 Aug; 8: 13-15. DISCLOSURES: No relevant relationships by Bisma Alam, source=Web Response No relevant relationships by Amee Patrawalla, source=Web Response