Bezold's abscess with intracranial complications of mastoiditis in an immunocompetent adult: A rare case

Bezold's abscess is a very rare complication of mastoiditis, where the infection erodes through mastoid cortex and causes deep neck abscess. Bezold's abscess with concomitant intracranial complications of mastoiditis is even rarer. We reported a 19-year-old man with retroauricular pain and bilateral ear discharge for 10 years. Mastoid high-resolution CT (HRCT) showed opacification in middle-ear cavity and destruction of both right mastoid and occipital bone. Contrast-enhanced neck CT showed deep neck abscess, extending to thoracic region. Contrast-enhanced cerebral CT showed right sigmoid sinus thrombosis, fluid collection in infratentorial subdural space, pneumocephalus, and hydrocephalus. Diagnosis was mastoiditis with Bezold's abscess and intracranial complications. Patient underwent surgical drainage. Microbiological culture showed Enterococcus faecalis and Proteus mirabilis. Imaging is important to diagnose mastoiditis and evaluate both intracranial and extracranial complications. CT is the imaging modality of choice for mastoiditis. HRCT is preferable because it can show temporal bone lesions in more detail. Contrast-enhanced neck CT is useful to evaluate soft tissue involvement, while contrast-enhanced cerebral CT can evaluate intracranial complications.