Otogenic Lateral and Transverse Sinovenous Thrombosis in a Child: A Case Report

Acute otitis media (AOM) is common in children, but intracranial complications such as meningitis, cerebral abscess, and cerebral venous sinus thrombosis are rare and can be potentially life-threatening. This case describes a three-year-old boy who presented to the emergency room following one week of coryza, fever, cough, malaise, and otalgia, along with three days of severe headache and vomiting. Physical examination revealed hyperemia and bulging of both tympanic membranes on otoscopy, along with an elevated erythrocyte sedimentation rate and elevated levels of leukocytes, C-reactive protein, and D-dimer. Cranial computed tomography scan revealed soft tissue density occupying the mastoid cells bilaterally and enlargement of the right transverse and sigmoid venous sinuses; magnetic resonance imaging of the brain revealed thrombophlebitis in the right internal jugular vein and thrombosis in the transverse and sigmoid sinuses. The diagnosis was bilateral AOM with otogenic lateral right sinus thrombosis, and the patient had also developed bilateral sixth cranial nerve paresis and cerebellitis. He made a full recovery without any sequelae, following treatment that included the placement of tympanostomy tubes in both ears, a 21-day course of systemic antibiotics, and two weeks of anticoagulation therapy with low molecular-weight heparin. Follow-up showed clinical improvement and normalization of inflammatory markers; the radiological images showed complete resolution of thrombosis. Since otogenic lateral sinus thrombosis symptoms can mimic uncomplicated AOM, maintaining a high index of suspicion is essential in preventing fatal outcomes and ensuring favorable recovery in pediatric patients.