Imaging Clinic: Destructive Temporal Bone Osteomyelitis in an Infant-CT and 3D Findings

Area of Science:

• Pediatric Otolaryngology
• Infectious Diseases
• Pediatric Infectious Diseases

Background:

• Acute mastoiditis is a common complication of acute otitis media in children.
• Progression to temporal bone osteomyelitis with cortical necrosis is rare in infants.
• This case highlights a rare presentation of refractory acute mastoiditis in a 1-year-old infant.

Purpose of the Study:

• To report a rare case of destructive temporal bone osteomyelitis in an infant.
• To emphasize the diagnostic and therapeutic challenges in such cases.
• To underscore the importance of early intervention and targeted treatment.

Main Methods:

• A 1-year-old infant with refractory acute mastoiditis was evaluated.
• High-resolution computed tomography (CT) with 3D reconstruction was used for imaging.
• Surgical intervention included subtotal mastoidectomy and radical debridement.
• Deep intraoperative cultures and histopathology were performed.
• Treatment involved targeted linezolid therapy.

Main Results:

• CT revealed extensive cortical loss of the temporal bone.
• Deep intraoperative cultures identified multidrug-resistant Staphylococcus hominis.
• Histopathology confirmed osteomyelitis.
• The infant showed rapid clinical improvement with targeted linezolid therapy.
• A 4-week course of linezolid resulted in complete clinical and laboratory resolution.

Conclusions:

• Infant temporal bone osteomyelitis is a rare but severe complication of acute mastoiditis.
• Early and accurate imaging (CT) is crucial for diagnosis.
• Deep tissue sampling for culture and histopathology is essential for identifying causative agents and confirming the diagnosis.
• Targeted antibiotic therapy, guided by culture results, is critical for successful management.
• Prompt surgical debridement and appropriate antibiotic treatment can lead to favorable outcomes in these rare cases.