Management of Complications of Acute Otomastoiditis in Solid Organ Transplant Patients.

BACKGROUND There are over 183,000 patients living with a functioning solid organ transplant in the United States, and almost no data exist discussing complications of acute otomastoiditis in this vulnerable population. Early recognition and treatment of acute otomastoiditis is essential in patients whose immune system is not normal, as progression can lead to sepsis, meningitis, brain abscess, Bezold's abscess, sigmoid sinus thrombosis, or other potentially fatal sequelae. METHODS Case report with extensive literature review. RESULTS A 63 year-old man presented 3 years after cadaveric renal transplant with otorrhea and altered mental status. His acute otitis media progressed to meningitis with sigmoid sinus thrombosis and sepsis, and management included IV and otic antibiotics, tympanostomy tube placement, and cortical mastoidectomy. The patient made a full recovery without residual neurologic deficit. CONCLUSION Extrapolating data from patients immunosuppressed for other reasons, patients immunosuppressed after solid organ transplant should receive prompt recognition and aggressive treatment of acute otomastoiditis to prevent or address potentially devastating intracranial or systemic complications.