Bilateral acute mastoiditis during Epstein-Barr virus infection in a child with alagille syndrome: a case report and scoping review.

BACKGROUND

Bilateral acute mastoiditis is an uncommon complication of acute otitis media and is often associated with systemic infections or underlying predisposing conditions. Viral infections, particularly Epstein-Barr virus (EBV), may facilitate secondary bacterial complications in susceptible pediatric patients. Alagille syndrome, a multisystem genetic disorder, may further increase vulnerability to severe infections due to immune and anatomical factors.

METHODS

We report a case of bilateral acute mastoiditis occurring in a child with Alagille syndrome during acute EBV infection: clinical, laboratory, microbiological, and radiological findings were collected and analysed. Furthermore, a scoping review was conducted to contextualize diagnostic and therapeutic strategies in pediatric mastoiditis.

RESULTS

A 12-year-old boy with known Alagille syndrome presented with persistent fever during confirmed EBV infection. During hospitalization, he developed clinical signs of bilateral mastoiditis. Contrast-enhanced computed tomography confirmed bilateral mastoid involvement. Blood cultures yielded Streptococcus pneumoniae. The patient was treated with intravenous broad-spectrum antibiotics (ceftriaxone and vancomycin) and underwent bilateral myringotomy with drainage. Clinical conditions improved rapidly, allowing step-down to oral antibiotic therapy and complete recovery without complications.

CONCLUSIONS

This case underscores the rare association between bilateral mastoiditis, EBV infection, and Alagille syndrome and highlights the potential interplay between viral-induced immune dysregulation and genetic susceptibility in promoting severe bacterial complications. Early recognition, appropriate antimicrobial therapy, and timely surgical intervention are essential to ensure favourable outcomes. Children with underlying genetic conditions may require closer monitoring during systemic viral infections to prevent severe complications.