Case Report: Child with Late Diagnosis of Mastoiditis

Introduction: Mastoid is the most frequent complication of media otitis. Streptococcus pneumoniae is the most common microorganism. It presents with fever, hyperemia, and retroauricular edema; ear protrusion with disappearance of the retroauricular sulcus; and otorrhea. Clinical diagnosis is associated with imaging examination. Complete blood count shows leukocytosis. Treatment is carried out with intravenous antibiotics and drainage of the abscess, while simple mastoidectomy is being discussed by some authors.

Objective: Report a case of child with late diagnosis of mastoiditis.

Case report: A 4 year old, female, resident of Divino. The child was forwarded to HSJA's ICU with earache, high fever, prostration, and erythema at the left retroauricular region with ear protrusion. She was admitted to another hospital, using intravenous antibiotics without clinical improvement. Otoscopy showed left tympanic membrane bulging and blood count with leukocytosis. Magnetic resonance imaging mastoid contrast shows a bilateral mastoiditis increased soft tissue and abscess formation at the left side with intracranial extension and involvement of the sigmoid sinus on the same side. Patient was referred to the surgical center where abscess drainage in the left mastoid under general anesthesia was performed and a penrose drain was placed and antibiotic therapy was maintained. Patient progressed well.

Conclusion: Mastoiditis is the most common complications of media otitis. It corresponds to 0.5% of the cases, and the principal agent involved is S. pneumoniae. The early diagnosis has fundamental importance and the correct treatment to avoid complications and still death. Patient evolved satisfactorily with no complications and is in ambulatorial monitoring.

Keywords: Mastoiditis, S. pneumoniae, media otitis.