Acute otitis media and cholesteatoma of the middle ear complicated with brain abscess

Abstract

Although acute otitis media can occur at all ages, it is more common in children, becoming a common cause of visits to the emergency room. Despite advances in diagnosis and treatment, sometimes this condition can be complicated by brain abscesses, meningitis, mastoid abscess and others. We present the case of a 19-year-old male patient, of Bangladeshi origin, who presented to the emergency room of Hamad General Hospital, Doha, Qatar, with intense headache, a history of otitis media, previously treated with augmentin, who began to convulse during his hospital stay. He was studied by means of Computerized Axial Tomography (CAT) of the skull with intravenous contrast, performed as an emergency. A large space-occupying lesion was diagnosed, surrounded by significant perilesional edema, interpreted as a large brain abscess resulting from otitis media and cholesteatoma with erosion of the tegmentum. He underwent emergency surgery, draining 500 mL of pus. He was followed up by CT scanning and MRI, showing a torpid progress. Serial cultures revealed superinfection with methicillin-resistant Staphylococcus aureus, treated with vancomycin and then meropenem, with unsatisfactory results. The clinical manifestations became even more complicated with hemorrhage from the surgical bed, later with segmental pneumonia, anemia and multiple organ failure, progressing torpidly until a fatal outcome. The use of imaging techniques for diagnosis and monitoring of middle ear conditions and the lethality of complications of otitis media were evidenced.