Primary central nervous system lymphoma mimicking an otitis media complication: an unusual presentation with sigmoid...

Primary central nervous system lymphoma (PCNSL) rarely presents with isolated otologic symptoms, and such cases are frequently misdiagnosed as infectious complications. We present a unique case of PCNSL initially manifesting as sigmoid sinus thrombosis.

A 70-year-old male presented with right ear pain and hearing loss. Initial imaging demonstrated sigmoid sinus thrombosis, and empirical treatment for presumed otitis media complication was initiated. The patient's clinical course, advanced neuroimaging, and histopathological findings were analyzed.

Despite targeted medical therapy, the patient's symptoms persisted. Repeat neuroimaging revealed an infiltrative lesion involving the temporal bone and posterior fossa. Histopathological analysis confirmed diffuse large B-cell lymphoma, a subtype of PCNSL. The patient commenced systemic chemotherapy with ongoing clinical follow-up.

This case underscores the importance of considering malignancy in patients with persistent otologic symptoms unresponsive to optimal therapy. The overlap between benign and malignant middle ear pathologies can obscure early diagnosis. Prompt recognition, comprehensive imaging, and multidisciplinary management are crucial to improving prognosis and survival in atypical PCNSL presentations.