2021 Volume 114 Issue 11 Pages 827-835
With the recent advances in antimicrobial agents and imaging studies, otogenic intracranial complications have become rare. Herein, we present the case of a patient with multiple brain abscesses that developed 2 months after repeated exacerbations and remissions of refractory otorrhea. A 55-year-old man was diagnosed as having mastoiditis by CT, although he did not present with typical symptoms, and was treated with antimicrobial agents for about 2 weeks. During the follow-up, he presented with fever, headache, and vomiting and was referred to our university hospital. Along with the fact that the latter symptoms appeared shortly after the end of the antimicrobial treatment, the CT and MRI findings suggested masked mastoiditis, which caused sigmoid sinus thrombosis and multiple brain abscesses. After 4 months of antimicrobial therapy and several craniotomies, the patient recovered. Factors contributing to the severity of the disease in this patient included underlying diabetes mellitus, immunosuppressive state induced by steroid therapy, and infection with Streptococcus intermedius. Appropriate early diagnosis, examination, and treatment, as well as adequate follow-up are mandatory for the prevention of severe cryptogenic mastoiditis.
