Case report: Otitis media with subsequent mastoiditis and cerebral herniation in a patient with Arnold chiari malformation

We present the case of a 13-year-old boy who unexpectedly needed to be resuscitated at home after an assumed uncomplicated otitis media. Imaging at our clinic showed mastoiditis and a cystoid mass in the left cerebellopontine angle compressing the brainstem, as well as an Arnold-Chiari-Malformation. Both the laboratory examination of cerebrospinal fluid (CSF) and surgical biopsy with pathological evaluation of the mastoid supported the inflammatory etiology of the mass. Microbiologically, Streptococcus intermedius was detected in the blood culture and CSF. Due to brain death, which most likely already existed preclinically, the organs were released for donation during the course. Our case demonstrates a very rare lethal complication of acute otitis media on the basis of a cerebral malformation and emphasizes the need to stay alert when patients complain of symptoms after assumed resolution.

Automated summary

In this case report, we describe a 13-year-old boy who experienced a life-threatening complication of acute otitis media due to an underlying cerebral malformation. Imaging revealed mastoiditis and a cystoid mass compressing the brainstem in the left cerebellopontine angle, along with an Arnold-Chiari malformation. Laboratory examination and pathological evaluation confirmed an inflammatory etiology. Streptococcus intermedius was detected in both blood and cerebrospinal fluid cultures. The patient's brain death allowed for organ donation. This case highlights the importance of vigilance and follow-up when patients present with symptoms after assumed resolution of otitis media.