A previously well, human immunodeficiency virus (HIV)-positive boy, presented with features of chronic mastoiditis with no intracranial complications. Intraoperative findings revealed a chronic granulomatous infection. Culture of pus swabs grew Nocardia asteroides, sensitive to trimethoprim and sulphamethoxazole. The child completed 12 months of treatment. There are very few case reports on N. mastoiditis in the literature, and the incidence of this as a complication of otitis media is unknown. To the best of our knowledge, this is the first case report of N. mastoiditis from Africa.
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