A Typical Bezold Abscess With an Atypical Aetiology

This study aims to present a case of temporal bone (TBP) paraganglioma with an insidious clinical presentation, deviating significantly from the typical hearing loss and pulsatile tinnitus pattern.

A 70-year-old lady presented to the emergency department with a five-day history of right progressive later cervical swelling extending to the mastoid region and chronic worsening purulent otorrhea. The clinical and radiological findings confirmed the presence of a chronic middle ear process complicated by a Bezold abscess.

The patient underwent a right-modified radical mastoidectomy with multiple biopsies and drainage of the neck abscess. The histology revealed a temporal bone paraganglioma with the classic Zellballen pattern and characteristic immunohistochemistry. The patient denied any further intervention.

This is the first case of an isolated jugulotympanic paraganglioma presenting as a Bezold abscess. Meticulous intraoperative biopsies and a high grade of suspicion of an underlying pathology are of supreme importance for the diagnosis of these rare entities.