European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2025
Primary central nervous system lymphoma mimicking an otitis media complication: an unusual presentation with sigmoid sinus thrombosis.
СтатьяКлинический случайНазвание и аннотация: Перевод пока не подготовлен
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Ensari Nuray, Biten Ferhan, Çetinkaya Erdem Atalay, Gencer Elif Sarıönder, Gömceli Yasemin Biçer, Uyar Ramazan, Gür Özer Erdem
Аннотация
BACKGROUND: Primary central nervous system lymphoma (PCNSL) rarely presents with isolated otologic symptoms, and such cases are frequently misdiagnosed as infectious complications. We present a unique case of PCNSL initially manifesting as sigmoid sinus thrombosis.
METHODS: A 70-year-old male presented with right ear pain and hearing loss. Initial imaging demonstrated sigmoid sinus thrombosis, and empirical treatment for presumed otitis media complication was initiated. The patient's clinical course, advanced neuroimaging, and histopathological findings were analyzed.
RESULTS: Despite targeted medical therapy, the patient's symptoms persisted. Repeat neuroimaging revealed an infiltrative lesion involving the temporal bone and posterior fossa. Histopathological analysis confirmed diffuse large B-cell lymphoma, a subtype of PCNSL. The patient commenced systemic chemotherapy with ongoing clinical follow-up.
CONCLUSION: This case underscores the importance of considering malignancy in patients with persistent otologic symptoms unresponsive to optimal therapy. The overlap between benign and malignant middle ear pathologies can obscure early diagnosis. Prompt recognition, comprehensive imaging, and multidisciplinary management are crucial to improving prognosis and survival in atypical PCNSL presentations.
METHODS: A 70-year-old male presented with right ear pain and hearing loss. Initial imaging demonstrated sigmoid sinus thrombosis, and empirical treatment for presumed otitis media complication was initiated. The patient's clinical course, advanced neuroimaging, and histopathological findings were analyzed.
RESULTS: Despite targeted medical therapy, the patient's symptoms persisted. Repeat neuroimaging revealed an infiltrative lesion involving the temporal bone and posterior fossa. Histopathological analysis confirmed diffuse large B-cell lymphoma, a subtype of PCNSL. The patient commenced systemic chemotherapy with ongoing clinical follow-up.
CONCLUSION: This case underscores the importance of considering malignancy in patients with persistent otologic symptoms unresponsive to optimal therapy. The overlap between benign and malignant middle ear pathologies can obscure early diagnosis. Prompt recognition, comprehensive imaging, and multidisciplinary management are crucial to improving prognosis and survival in atypical PCNSL presentations.