Secondary otogenic meningoencephalitis with recurrent abscesses in the practice of an infectious disease specialist

Abstract

This article describes a clinical case of secondary otogenic meningoencephalitis complicated by the formation of multiple brain abscesses in an adolescent patient. The pathological process developed against the background of long-standing chronic suppurative otitis media with a torpid course. The key premorbid conditions were secondary immunodeficiency caused by extrahepatic portal hypertension, as well as the absence of vaccination against pneumococcal and other preventable infections. The disease course was characterized by the development of severe intracranial complications: thrombosis of the sigmoid sinus and internal jugular vein, epidural empyema, and multiple abscesses of cerebral structures. Treatment tactics included emergency surgical intervention (canal wall-down mastoidectomy), long-term staged empirical and subsequent targeted antimicrobial therapy using drugs with a high ability to penetrate the blood-brain barrier. A favorable outcome was achieved thanks to the coordinated actions of a multidisciplinary team (infectious disease specialists, otorhinolaryngologists, neurosurgeons, neurologists, immunologists). This clinical observation serves as a basis to discuss risk factors, difficulties of differential diagnosis, the need to improve microbiological diagnostic methods, and the critical importance of interdisciplinary collaboration in the management of patients with severe intracranial infectious complications.