SHM Converge Scientific Abstract ePoster Gallery-Turns Out It Wasn't Just Gas

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A 7-year-old boy with hypohidrotic ectodermal dysplasia and recurrent sinusitis was hospitalized after 8 days of fever and joint pains, following several recent episodes of fever, nasal impetigo, and positive group A streptococcal (GAS) throat swabs without sore throat. He had been treated twice with azithromycin because of reported allergies to amoxicillin, cephalosporins, and clindamycin. Initial workup was unrevealing except for rhinovirus and GAS on throat culture, so he was discharged on azithromycin and intranasal mupirocin. Five days later, he returned with diplopia, headaches, and fever.<br /><br />On re-evaluation, he appeared non-toxic but had a temperature of 40.1°C, dense cerumen impaction, and papilledema. Labs showed elevated inflammatory markers and leukocytosis. Blood cultures and nasal swab were positive for Streptococcus pyogenes. Lumbar puncture revealed elevated opening pressure. Imaging showed intracranial hypertension, erosion of the left mastoid air cells with sigmoid plate dehiscence, sinusitis, bilateral mastoid effusions, and a non-occlusive left transverse sinus thrombosis.<br /><br />He was diagnosed with mastoiditis due to recurrent GAS infection, complicated by bacteremia, venous sinus thrombosis, and increased intracranial pressure. He underwent left myringotomy and drainage, then received IV antibiotics and anticoagulation. He improved and was discharged on linezolid, rivaroxaban, and acetazolamide, with complete symptom resolution and no recurrent fevers.<br /><br />The case highlights that hypohidrotic ectodermal dysplasia increases risk for recurrent respiratory and ear infections, and that recurrent GAS should prompt consideration of inadequate antibiotic coverage, macrolide resistance, and reassessment of reported beta-lactam allergies.

Asset Subtitle

Erin M. Finn

Meta Tag

Author List Elizabeth Thomas, Erin M. Finn, Katie L. Butler, Olivia Brown, Will Rearick

Category Clinical Vignettes

Concept Group A Streptococcal Infection

Concept Mastoiditis

Concept Recurrent Infection

Concept Hypohidrotic Ectodermal Dysplasia

Concept Intracranial Hypertension

Distinguished Non-Finalist

Presenter Organization University of North Carolina

Presenting Author Erin M. Finn

Track Pediatric

Keywords

hypohidrotic ectodermal dysplasia

recurrent group A streptococcal infection

mastoiditis

intracranial hypertension

transverse sinus thrombosis

bacteremia

sinusitis

papilledema

antibiotic allergy

macrolide resistance

Group A Streptococcal Infection

Mastoiditis

Recurrent Infection

Hypohidrotic Ectodermal Dysplasia

Intracranial Hypertension