Acute Mastoiditis Complicated by Meningitis: A Case Report and Condition Overview.

INTRODUCTION

Mastoiditis is a major complication of acute otitis media that, if left undiagnosed or untreated, can lead to meningitis. This case report shares the clinical course of a child with acute mastoiditis. The related discussion provides an overview of acute mastoiditis, including its presenting signs and symptoms, diagnostic testing, treatment, and outcome and prognosis.

CLINICAL FINDINGS AND DIAGNOSIS: A 9-year-old male patient presented with fever, symptoms of a viral upper respiratory infection, and tachycardia. His physical examination was remarkable for muscle hypotonia, asymmetrical pupils, and incomprehensible speech. Laboratory testing and imaging confirmed Streptococcus pneumoniae meningitis, acute mastoiditis, and hydrocephalus.

INTERVENTIONS: Within hours of admission, the patient's neurologic status deteriorated, requiring intubation and emergent ventriculostomy with external ventricular drain placement. Once he was stabilized, a right mastoidectomy with myringotomy tube placement was performed.

PATIENT OUTCOME: Ultimately, the patient underwent ventriculoperitoneal shunt placement and, after a 5-month hospitalization, had significant neurologic delays for which he received aggressive inpatient rehabilitation.

CONCLUSION

This case report and condition review highlight the importance of assessing for acute otitis media and recognizing early signs and symptoms of mastoiditis in all children to minimize disease progression and associated morbidity and mortality.