Tuberculosis Beyond Borders: A Rare Case of Infratemporal Fossa Infection Leading to Parotid Abscess and Mastoiditis

Tuberculosis (TB) remains a global health concern, with extrapulmonary TB (EPTB) comprising 15–20% of cases. Diagnosis is challenging due to nonspecific imaging findings, necessitating consideration in high-risk populations. Understanding TB’s pathogenesis, including lymphatic and hematogenous spread, is crucial for accurate diagnosis. Radiological assessments play a pivotal role in diagnosis and treatment planning. A 25-year-old male presented with left ear discharge and progressive pre- and infra-auricular swelling. Imaging revealed extensive involvement of the parotid and mastoid regions, posing diagnostic dilemmas. Microbiological confirmation via USG-guided aspiration confirmed mycobacterial TB with Rifampicin resistance, prompting prompt initiation of anti-tubercular therapy. TB extending to the parotid and mastoid regions is rare but warrants consideration in ITF lesions. This case emphasizes the importance of maintaining a high index of suspicion for TB, utilizing advanced imaging modalities, and obtaining microbiological confirmation for precise diagnosis and timely intervention. Further research is needed to optimize diagnostic and therapeutic approaches for atypical ITF infections.