One child, Difference Complications of Acute Mastoiditis

Acute mastoiditis (AM) is a suppurative infection of the mastoid air cells with symptoms of less than one month`s duration.

The clinical spectrum of mastoiditis ranges from a lack of symptoms with spontaneous resolution to progressive disease with life-threatening complications.

A 28-month-old girl, with updated immunization schedule and history of recurrent acute otitis media (AOM), was evaluated in day (D1) of fever, rhinorrhea and frontal headache and treated symptomatically for upper airway infection.

In D4, for persistence of fever, was re-evaluated and diagnosed with bilateral AOM. Started treatment with oral cefuroxime and betamethasone, with apyrexia since D6.

In D7 noticed left retro-auricular inflammatory signs and poor feeding. She was admitted with the diagnosis of left AM and started intravenous ceftriaxone, nasal and topical corticosteroids.

In D9 restarted fever and in D11 worsened left retro-auricular inflammatory signs with significant swelling and fluctuation. Neurological examination was normal. Cranial computed tomography with intravenous contrast revealed bilateral mastoiditis, left subperiosteal abscess, left temporal extra-axial empyema and suspicion of ipsilateral partial thrombosis, all findings confirmed by cranial magnetic resonance.

She was submitted to left mastoidectomy and myringotomy, without isolation of agent in the exudate. Ceftriaxone dose was increased to meningeal doses and started on intravenous metronidazole and dexamethasone and subcutaneous enoxaparin.

She had progressive clinical, analytical and imaging improvement. Completed 4 weeks of antibiotic and enoxaparin treatment and 10 days of dexamethasone and was discharged with oral hypocoagulation.

Currently, after four months of multidisciplinary follow-up, she had no complications or sequels and keeps a normal psychomotor development.

Complications of mastoiditis, although rare, may be serious with significant morbidity and mortality.

An unfavorable clinical course of AM should raise the suspicion of complications and the need of imaging evaluation.