SHM Converge Scientific Abstract ePoster Gallery-An Unusual Case of Mastoiditis in an Unvaccinated Patient

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This case describes a 19-year-old Mennonite male with no past medical history and no childhood vaccinations who presented with one week of left ear pain, fever, tachycardia, mastoid tenderness, and a ruptured left tympanic membrane. Laboratory studies showed leukocytosis and elevated neutrophils. Because of the duration of symptoms and high suspicion for mastoiditis, CT imaging was obtained and demonstrated near-complete opacification of the left mastoid, middle ear, and external auditory canal with two areas of bony erosion, confirming acute mastoiditis.<br /><br />The patient underwent emergent mastoidectomy with myringotomy and tympanostomy tube placement. Intraoperative cultures grew Streptococcus pyogenes, which was susceptible to ceftriaxone. A PICC line was placed, and he was discharged on six weeks of outpatient parenteral antimicrobial therapy with ceftriaxone and ofloxacin ear drops, along with ENT follow-up.<br /><br />The report emphasizes that acute mastoiditis is a rare but serious nonmeningeal complication of otitis media caused by extension of infection into adjacent mastoid structures. Typical findings include fever, severe ear pain, postauricular swelling or tenderness, ear drainage, and tenderness over the pinna. Diagnosis is supported by imaging, and treatment usually includes broad-spectrum antibiotics plus myringotomy for drainage and culture; mastoidectomy is required in severe cases.<br /><br />The case highlights that lack of vaccination may contribute to more severe infection and reinforces the importance of recognizing clinical signs, promptly evaluating suspected mastoiditis, and initiating appropriate treatment quickly to prevent complications.

Asset Subtitle

Anna-Maria South

Meta Tag

Author List Anna-Maria South, Sydney Winchester

Category Clinical Vignettes

Concept Mastoiditis

Concept Broad-Spectrum Antibiotic

Concept Otitis Media

Concept Mastoid Tenderness

Concept Postauricular Swelling

Distinguished Non-Finalist

Presenter Organization University of Kentucky

Presenting Author Anna-Maria South

Track Adult

Keywords

acute mastoiditis

otitis media

mastoidectomy

tympanic membrane rupture

Streptococcus pyogenes

bony erosion

CT imaging

leukocytosis

nonmeningeal complication

vaccination status

Mastoiditis

Broad-Spectrum Antibiotic

Otitis Media

Mastoid Tenderness

Postauricular Swelling