Acute Otitis media with fulminant progression

Background Acute otitis media with coexisting mastoiditis is a typical clinical entity in the pediatric population and occurs rarely in adults. Life-threatening complications can usually be managed with immediate surgical intervention.

Study design and Methods This case report describes a 54-year-old female patient with acute otitis media with mastoiditis, that rapidly progressed to terminal septic shock. The Patient was brought to the critical care area intubated and stabilized after being found unconscious at home. A few hours earlier, she had been seen by an otolaryngologist and referred to the hospital due to acute mastoiditis, which she did not follow up on.

Results A CT scan revealed partial opacity of mastoid process and right tympanic sinus. Additionally, pneumocephalus and right transverse sinus thrombosis with cerebral congestive infarcts were found. The patient was admitted immediately for surgery. During anesthesia induction, a unilateral right-sided dilated pupil was observed. Subsequent CCT showed incipient cerebral herniation caused by cerebral edema. The patient underwent decompressive hemicraniectomy performed by neurosurgeons, followed by mastoidectomy and tympanic drainage with the placement of a ventilation tube. Concurrently, she received ceftriaxone and ampicillin. The patient was transferred to the intensive care unit on ventilator support in a hemodynamically unstable condition and unfortunately died the following day.

Conclusions The case illustrates an exceptionally rapid progression of acute otitis media and mastoiditis leading to a fatal outcome, which demonstrates the importance of prompt early diagnosis and surgical intervention.

Publikationsverlauf

Artikel online veröffentlicht:
19. April 2024