Authors: Pires Borges Joana, Aguiar Cristina, Correia Aníbal, Neto Mariana, Barge Sidnei, Moreira Diana.
We report a case of a 5-year-old healthy child that presented to the emergency department with a 4-day history of prostration, headache, cervical pain, and fever. She had a history of acute otitis media 8 weeks before. She presented a hyperaemic and bulged left tympanic membrane as well as limitation of left eye abduction. Blood tests showed increased inflammatory markers. She performed a cerebral, cervical and ear region computed tomography showing the left mastoid region, left ear, and left petrous apex filled with secretions in relation with mastoiditis and petrositis. A lumbar punction was performed and treatment with ceftriaxone 100mg/kg/day was initiated. After exclusion on meningitis, the antibiotic was changed cefuroxime 150mg/Kg/day.
She was submitted to a left myringotomy with tympanostomy tube placement and, after, she presented a rapid improvement of cervical pain and headache with no more documented fever. During hospitalization, she performed a magnetic resonance imaging that show signs of mastoiditis and petrositis. There was no evidence of cerebral extension of inflammatory process and all the venous sinus presented preserved flow. At discharge, she was clinically asymptomatic with normalization of inflammatory parameters. At physical examination she still presented limitation of left eye abduction. She completed a total of 6 weeks of antibiotic treatment. Due to persistent VI cranial nerve palsy one month after discharge, an injection of botulinum toxin was performed, with complete resolution.