Temporal Bone Osteomyelitis in a Child Closely Resembles Lateral Sinus Thrombosis: A Case Report

Temporal bone osteomyelitis is more commonly seen in immunocompromised patients and is very rare in non-immunocompromised individuals. Mucormycosis is a fulminating fungal infection caused by Mucor which is a saprophytic fungus commonly seen in diabetic patients. Here we report a case of temporal bone osteomyelitis in a child with a traumatic history which was causing clinical features of lateral sinus thrombosis. The patient was successfully treated and doing well post-operatively.

An 11-year-old girl was reported to the emergency dept with fever and headache for 2 weeks. She had a fever of 100-102 °F without chills and rigors which was associated with severe headache on the right side and not associated with any vomiting, nausea, or aura. The patient did not have any other significant complaints except a history of falling 2 years previously when she was 9 years of age. The patient was admitted and a complete evaluation was performed clinically and radiologically. High-resolution computed tomography (HRCT) of the temporal bone was suggestive of soft tissue density at the sigmoid sinus of the right mastoid. The patient underwent surgery for debridement, and the tissue was sent for diagnosis. This revealed mucormycosis of the temporal bone and the patient started medical management. At the present date, the patient remains under follow up.

Fungal chronic osteomyelitis is a disease among immune-compromised patients involving the temporal bone, and is very rare. In particular mucormycosis is very rare in the temporal bone but is not expected in normal individuals. HRCT of the temporal bone is the gold standard investigation, and tissue biopsy is diagnostic. Tissue debridement and long-time medical management with anti-fungal medication is mandatory to achieve good results.