Document Type

Conference Proceeding

Publication Date

5-2-2025

Abstract

Introduction Otomastoiditis, a common ear infection, can progress to severe complications such as skull base osteomyelitis (SBO) and cerebral venous thrombosis (CVT), though these are rare. The incidence of CVT in the context of otomastoiditis is approximately 3 to 4 cases per million adults, but it remains life-threatening. Pre antibiotics, CVT secondary to otomastoiditis showed a near100% mortality rate. Today, early recognition and multidisciplinary management make these complications preventable. This case raises the importance of in-time diagnosis and management in averting severe outcomes such as neurological deficits and death. Case Report A 78-year-old female with uncontrolled insulin-dependent diabetes (HbA1c 10.3%) and chronic kidney disease (CKD) developed SBO and CVT following otomastoiditis. She presented with a six-week history of left-sided ear pain, discharge, and hearing loss after a dental procedure. Initial treatments with ear drops and oral antibiotics, including antifungals for Candida lusitaniae, failed to resolve her symptoms. CT imaging revealed temporal bone otomastoiditis with osteomyelitis, prompting intravenous (IV) antibiotic therapy with cefepime, Diflucan, and Ciprodex. Despite treatment, her condition worsened, and an MRI revealed sigmoid sinus thrombosis, a complication of CVT. She was transferred for further management, including mastoidectomy and neuro-interventional care. At the new facility, the patient underwent myringoplasty with T-tube placement, and magnetic resonance venography (MRV) confirmed partially occlusive thrombosis. IV heparin was initiated, but contrast-induced kidney injury required hemodialysis. Following stabilization, she was discharged with a peripherally inserted central catheter (PICC) line for four weeks of IV Zosyn and a three-month course of Eliquis. While her infection was controlled, she continued to experience mild hearing loss, ear pain, and drainage. Discussion This case shows the importance of early imaging pro, per cultures, and antibiotics management, particularly in high-risk patients with comorbidities like diabetes and CKD. Although otomastoiditis is common, delays in diagnosis and treatment can lead to severe complications. In this patient, initial oral antibiotics were insufficient, and by the time appropriate imaging was performed, her condition had progressed to CVT. Early intervention with broad-spectrum antibiotics and imaging (CT and MRV) is critical to prevent such complications. Managing CVT secondary to otomastoiditis requires an interdisciplinary approach involving infectious disease specialists, ENT surgeons, and neurosurgeons. Timely management with IV antibiotics, anticoagulation therapy, and surgical interventions is crucial in preventing long-term neurological deficits and death. Although we had challenges due to the patient's multiple comorbidities, careful monitoring and heparin use helped mitigate further thrombotic complications. Conclusion This case demonstrates that CVT is preventable through early diagnosis and aggressive treatment of otomastoiditis, particularly in high-risk patients with diabetes and CKD. Prompt imaging, appropriate antibiotic therapy, and interdisciplinary care significantly reduce the risk of life-threatening complications. Further research is needed to establish guidelines for anticoagulation therapy in infection-related CVT and improve outcomes through evidence-based practices.

Comments

American College of Physicians Michigan Chapter and Society of Hospital Medicine Michigan Chapter 2025 Resident and Medical Student Day, May 2, 2025, Troy, MI

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