Initial diagnosis of a sporadic Burkitt Lymphoma masquerading as acute mastoiditis with facial paralysis and vestibular failure

Introduction Cancer is rare in children. Hematopoietic malignancies are the most common subtype of pediatric malignancy. The disease is typically found in the lymph nodes and much less commonly in bony anatomy. Temporal bone involvement is often asymptomatic. Primary presentation in the mastoid is rarely reported in the literature. Facial paralysis and vestibular failure in this context is very rare.

Case Report We present a case of a 12 year old boy, who was presented by paedriaticians under diagnosis of meningitis with facialis paralysis on the left side and vestibular failure. Laboratory analysis showed anemia and thrombocythemia as well as increased lactate dehydrogenase. Leucocytes were normal, CRP was elevated. CS fluid analysis was negative for evidence of both malignancy an infection. The otososcopy revealed a dolent swelling from the posterior wall of the the auditory canal causing obstruction of the lumen. Retroauricular swelling oder redness was not detected. A CT scan of the temporal bone showed a completely opacified auditory canal, middle ear and mastoid with localised bone erosion. Under suspected diagnosis of subacute mastoiditis a left mastoidectomy and a tympanotomy was performed. During the procedure a grey fibroelastic friable lesion was found in the mastoid cavity with localised erosion of the posterior wall of the external ear canal and the bone coverage of the sinus sigmoideus. Histopathologic examination revealed a Burkitt Lymphoma (BL). He was EBV negative.

Conclusion  The involvement of the temporal bone in hematopoietic malignancies is very rare. In literature only 4 cases of BL associated with the temporal bone were described. In every atypical case of acute mastoiditis a non-infectious basis should be suspected.

Publication History

Article published online:
12 May 2023