A woman in her 50s was diagnosed with a case of “turkey ear”, in which a tuberculous skin infection caused her right ear to swell progressively over many years until it reached an enormous size.
The term turkey ear refers specifically to an infection of the ear lobe that causes the skin to be reddish, bumpy and hard to touch; the comparison with the turkeys may be a reference to the birds’ fleshy and bumpy necks, but the case reports do not specify which characteristic inspired the name.
In the case of women, the infection started in childhood and progressed slowly over time, making the swollen ear a reddish-brown color, according to a case report published on March 3 in the journal JAMA Dermatology.
An examination, conducted at a medical center in Israel, also revealed that regions of the woman’s ear had acquired an “apple gelatin appearance”, literally meaning that the color resembled that of a gelatin made of boiled apples, the authors wrote. The term “apple jelly” also refers to the texture of the protruding nodules on the infected skin, which look gelatinous to the touch, according to a 2013 report in the magazine. Infectious diseases in clinical practice.
“She was adamant that the lesion had been present since early childhood, but it had gradually increased” and began to leak a smelly secretion, the authors wrote.
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The woman originally went to the clinic in 2008 and received two months of treatment with four antibiotic drugs for the turkey ear; the treatment was then reduced to two drugs over the next seven months. The infection was improving with treatment, but she did not follow up until 2020, when doctors had a chance to reexamine it, the authors wrote. His infection had completely disappeared and his ear had returned to normal size. Only a scarred piece of skin remained as a mark of the infection.
Tuberculosis skin infections are caused by the same bacteria that infects the lungs, known as Mycobacterium tuberculosis, according to the case report. It is relatively rare for bacteria to infect the skin, however, compared to other sites of infection outside the lungs, such as lymph nodes, according to a 2012 report in Indian Journal of Dermatology.
Specifically, the woman with the turkey ear was diagnosed with “lupus vulgaris”, a condition in which the M. tuberculosis the infection progresses very slowly on the skin, changing its color and texture over several years. This is the most common manifestation of tuberculous infection on the skin.
Infection usually occurs when M. tuberculosis migrates to the skin from other parts of the body, often through the blood or lymphatic system. Very, very rarely, the condition can settle after a person receives Bacillus Calmette-Guérin (BCG) vaccine, designed to prevent tuberculosis, the authors noted. This unusual complication is estimated to occur in only 5 out of 1 million of these vaccinations, according to a 2016 report in the newspaper Dermatology Case Reports.
The BCG vaccine is not widely used in the United States, where control measures have effectively reduced the risk of infection, but the vaccine is still commonly administered to babies and children in countries where the condition remains common, according to the Centers for Disease Control and Infection (CDC).
“The chronic and relatively asymptomatic nature of [lupus vulgaris] can cause a significant delay in diagnosis, “the authors noted. In fact, the authors found several other case reports describing patients who had had lupus vulgaris for decades before being diagnosed.
In general, skin tuberculosis “has become rare in recent decades”, but the disease can still arise in unexpected places as people emigrate from regions where tuberculosis is endemic, the authors wrote. Therefore, dermatologists around the world should still consider lupus vulgaris as a possibility if they find patients with turkey ears or apple jam nodules, they wrote.
Originally published on Live Science.