Article in Japanese

A pediatric case with COVID-19 complicated otitis media, epidural abscess, and venous sinus thrombosis

Masaki KOKETSU¹⁾, Michio SUZUKI¹⁾, Kaoru KINOSHITA¹⁾, Toshiki TAKEO¹⁾, Daisuke OMORI¹⁾, Tatsuya FUKASAWA¹⁾, Yuji MIYAJIMA¹⁾, Tetsuo KUBOTA¹⁾

Epidural abscess and venous sinus thrombosis are rare complications associated with otitis media and sinusitis. We present a COVID-19 case with otitis media, epidural abscess and venous sinus thrombosis. The patient had a drug eruption during treatment, however, the immunoglobulin administration considering multisystem inflammatory syndrome in child (MIS-C) was successful in treating. A 10-year-old boy presented with fever, left ear pain, and headache. He was diagnosed with COVID-19 with a positive PCR test for severe acute respiratory syndrome coronavirus 2 on day two after illness. He was diagnosed with acute otitis media on day three and treated with oral antibacterial drugs. Although the fever resolved after antimicrobial treatment, the left ear pain and headache persisted. His illness was diagnosed with epidural abscess and venous sinus thrombosis based on CT and MRI findings and admitted to our hospital on day 12 after illness onset. Symptoms and laboratory findings improved with antimicrobial and anticoagulation therapy. However, the abscess did not resolve. Rash, fever, cervical lymphadenopathy, elevated C-reactive protein, and low blood counts were observed on day 26 after disease onset. The antimicrobial agent was changed with considering drug fever. Moreover, intravenous immunoglobulin was administered with considering MIS-C. On day 34, drainage was performed for the epidural abscess followed by antimicrobial agent administration for two weeks. Although otitis media and sinusitis are common diseases, they rarely complicate epidural abscess or venous sinus thrombosis. Therefore, intracranial disease should be identified in headaches during infectious disease.

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1）Department of Pediatrics, Anjo Kosei Hospital

Key words	COVID-19, otitis media, epidural abscess, venous sinus thrombosis, drug eruption
Received	April 21, 2023
Accepted	November 17, 2023

36 (1)：19─27,2024