A 12-Year-Old boy had a 3-month history of fever, headaches, nausea, dizziness, fatigue, and loss of appetite.
His medical history revealed repeated ear infections. Two years earlier, he had suffered from head trauma, which was followed by a few days of nausea and motor instability.
A physical examination showed a well-developed boy. Caries was noticed in 4 teeth with no jaw sensitivity. The results of the neurologic examination were normal, including hearing and vision.
A computed tomographic scan of the head showed a collection of fluid in the right mastoid bone with no destruction of mastoid cells. There was also a soft tissue mass in the middle ear (Figure 1 and Figure 2).
Five days later there was a sudden increase in the fever, with acute pain in the right ear. Otoscopy revealed a bluish brown discoloration of the tympanic membrane. Audiometry revealed conductive hearing impairment on the same side.
Rothschild M, Berger I, Lew S, Ophir D. Pathological Case of the Month. Arch Pediatr Adolesc Med. 1997;151(9):951-952. doi:10.1001/archpedi.1997.02170460089017