Recurrent otitis media and mastoiditis due to atypical mycobacteria

An eleven-year-old girl was operated on due to right-sided chronic otitis media with effusion. After three months, an impressive enlargement of the mucosal lining developed, for which thorough debridement of the middle ear and mastoid was performed. Histological examination revealed a granulomatous inflammation, with negative Ziehl-Neelsen staining. Standard bacteriological cultures revealed no pathogenic micro-organisms. Three weeks later the same clinical picture developed, once again followed by extensive surgical debridement. After a thorough diagnostic work-up an atypical mycobacterium was found, namely Mycobacterium abscessus--formerly named M. chelonei subspecies abscessus. Following appropriate antibiotic therapy the patient was symptom-free. Mycobacterial infections should be part of the differential diagnosis of persistent otorrhoea.