Subdural empyema, acute mastoiditis, and sinus venous thrombosis associatedwithStreptococcus pyogenesbacteremia: a rare case.

Subdural empyema, mastoiditis, and sinus venous thrombosis are rare infections that may lead to serious and potentially life-threatening complications. A 2-year-old male patient with no known underlying disease presented with a 2-day history of ear pain, sore throat, and fever. Physical examination revealed no significant pathology other than hyperemia of the left tympanic membrane. Intravenous ceftriaxone was initiated, and the patient was hospitalized because of persistent fever and poor oral intake. However, despite 3 days of treatment, the fever persisted, and an increase in acute phase reactants was observed. Subsequently, the patient developed hyperemia, swelling, and warmth in the area corresponding to the left mastoid region. Clindamycin was then added to the treatment regimen. Streptococcus pyogenes was isolated from the patient's blood culture. Brain magnetic resonance imaging revealed a partial thrombus in the left transverse sinus and a 2.5-cm subdural empyema in the lateral aspect of the left cerebellar hemisphere. Antithrombotic therapy was initiated for the patient. Ceftriaxone was administered intravenously for 14 days and clindamycin for 11 days. The total duration of oral and intravenous antibiotic therapy was completed in 6 weeks, and enoxaparin sodium was given for 3 months. This case highlights the need for awareness of the rare complications of persistent otitis media in pediatric patients. Conditions such as subdural empyema, mastoiditis, and sinus venous thrombosis can be successfully managed with timely diagnosis and appropriate treatment. Such complications should be considered in cases that do not respond clinically to appropriate antibiotic therapy.