Case 2-2013 "Cholesteatoma"

"A 20-Year-Old Man with Recurrent Ear Pain, Fever, and Headache", a CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL by Konstantina Stankovic and colleagues.
A 20-year-old man was transferred to this hospital because of recurrent ear pain for 8 months despite antibiotics.
8 months earlier pain developed in the right ear; a diagnosis of otitis media was made. During the next 7 months, pain recurred intermittently, despite antibiotics and antimicrobial therapy. Two weeks before admission, headache developed and gradually increased in severity. Four days before admission, he awoke at night with a severe occipital headache and stiff neck, with photophobia, phonophobia, fever, chills, and dizziness. Imaging showed opacification of the middle ears and mastoid air cells and erosion of the right temporal bone.
Mastoiditis, meningitis, proteus and peptostreptococcus bacteremia, and extensive venous sinus thrombosis developed. This patient's symptoms and signs are consistent with an infectious cause. His history and the bacteria identified in his blood are consistent with chronic otitis media, as opposed to recurrent acute otitis media. How can we explain the development of severe chronic otitis media that ultimately led to multiple intracranial complications in this man? The differential diagnosis includes an acquired cholesteatoma, a congenital cholesteatoma, and granulation tissue without a cholesteatoma.