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October 1995


Arch Otolaryngol Head Neck Surg. 1995;121(10):1200-1203. doi:10.1001/archotol.1995.01890100102018

Pathologic Quiz Case 1  Belmina N. Michael, MD; Salim Matar, MD; Daniel M. Siegel, MD, Stony Brook, NYA 64-year-old white woman who had traveled to the Tamshiyacu region of the Peruvian rain forest in July 1993 to visit with local shamans began to experience slight irritation, pain, and swelling in the right postauricular area that she attributed to a mosquito bite (Figure 1). Sharp shooting pains that radiated throughout her scalp and down her neck then developed. In addition, she became aware of a ticking sound before the pain ensued. The patient was seen by her physician in the United States 10 days after the onset of symptoms and was treated with amoxacillin and saltwater soaks. She was later admitted to an outside hospital, where intravenous antibiotic therapy was initiated because of worsening pain and the presumptive diagnosis of acute mastoiditis. The differential diagnosis included acute otitis media

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