A rare case report of cholesteatomatous chronic otitis media complicated by Bezold abscess, Citelli abscess, and sigmoid sinus thrombosis

Uncommon complications of cholesteatoma

Abstract

This case report presents a rare manifestation of cholesteatomatous chronic otitis media complicated by Bezold abscess, Citelli abscess, and sigmoid sinus thrombosis in a 35-year-old man. The patient presented with restricted neck movement, neck pain, fever, difficulty in oral intake, left mastoid tenderness, and otorrhea. Physical examination demonstrated a firm, nonfluctuant swelling extending from the left submandibular region to level III of the neck, along with purulent discharge in the left external auditory canal. Laboratory evaluation revealed markedly elevated inflammatory markers. Imaging studies, including temporal computed tomography, contrast-enhanced temporal magnetic resonance imaging, and magnetic resonance venography, confirmed a Bezold abscess extending into the parapharyngeal space, a Citelli abscess extending from the left suboccipital region toward the prevertebral space, and chronic thrombosis of the left sigmoid and transverse sinuses. Urgent surgical management was performed, including radical mastoidectomy, abscess drainage, mastoid cavity obliteration with abdominal fat, and cul-de-sac closure. Low molecular weight heparin was initiated preoperatively and continued postoperatively for three months to manage sigmoid sinus thrombosis. Postoperatively, intravenous antibiotics were administered, and inflammatory markers were monitored daily. Follow-up magnetic resonance imaging confirmed successful fat obliteration of the mastoid cavity. The patient completed a 28-day antibiotic course without complications and was discharged in stable condition; no pathological findings were identified during follow-up. This case emphasizes the importance of rapid diagnosis and timely surgical intervention in rare but potentially life-threatening complications of cholesteatomatous chronic otitis media.