Beyond Otitis Media: When Mastoiditis Leads to Life-Threatening Complications in Children.

Introduction: Acute mastoiditis, a complication of acute otitis media (AOM), remains a concern in children despite vaccines and antibiotics. Serious complications like cerebral venous sinus thrombosis (CVST) can be life-threatening. Case Presentation: A 4-year-old girl with fever, vomiting, and ear pain worsened despite amoxicillin treatment, developing headache, neck stiffness, and drowsiness. An ENT examination showed thickened tympanic membranes. Neurological symptoms, including headache, drowsiness, and neck stiffness, prompted lumbar puncture and initiation of ceftriaxone, with elevated CRP and leukocytosis supporting the clinical suspicion. Imaging confirmed otomastoiditis with epidural extension and CVST. MRI confirmed intracranial complications, prompting anticoagulation. She underwent mastoidectomy and tympanostomy tube placement, recovering well. Conclusion: Early imaging and multidisciplinary management are essential to prevent neurologic complications in children with mastoiditis.