Tsai Carmelle, Deramo Jennifer, Shen Xiaofan, Vandiver Kathleen, Mittal Vineeta
From the Division of Emergency Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia and The University of Pennsylvania, Philadelphia, PA.
Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Health System Dallas, TX.
Pediatr Emerg Care. 2020 May;36(5):e285-e287. doi: 10.1097/PEC.0000000000001348.
A 5-year-old previously healthy child presented with right-sided otalgia, right facial and temporal swelling, and right jaw pain in the setting of 6 days of low-grade fever. The child had no trauma, vomiting, or prior dental treatments. On physical examination, the patient had facial swelling, erythema, and tenderness over the right temporal region along with trismus, as well as pain on palpation of the right temporomandibular joint (TMJ). A computed tomography scan revealed otitis media, Luc's abscess, and TMJ septic arthritis requiring surgical drainage and intravenous antibiotics. The patient responded well to treatment and recovered without sequelae. Dr. Cardwell Luc first described Luc's abscess in 1913 as a rare complication of middle ear infection leading to an abscess in the infratemporal space. To our knowledge, our case is the first documented case of concurrent Luc's abscess and TMJ septic arthritis in a previously healthy child as complications of acute otitis media. This case highlights 2 rare complications of a common medical condition that pediatric emergency care providers should recognize due to the need for surgical intervention, without which there may be longstanding sequelae.
一名5岁既往健康的儿童，在低热6天的情况下，出现右侧耳痛、右侧面部及颞部肿胀和右侧颌部疼痛。该儿童无外伤、呕吐或既往牙科治疗史。体格检查时，患者右侧颞部区域有面部肿胀、红斑和压痛，伴有牙关紧闭，右侧颞下颌关节（TMJ）触诊时疼痛。计算机断层扫描显示中耳炎、卢氏脓肿和TMJ化脓性关节炎，需要手术引流和静脉使用抗生素。患者对治疗反应良好，康复后无后遗症。卡德韦尔·卢博士于1913年首次描述了卢氏脓肿，它是中耳感染导致颞下间隙脓肿的一种罕见并发症。据我们所知，我们的病例是首例记录在案的既往健康儿童并发卢氏脓肿和TMJ化脓性关节炎，作为急性中耳炎的并发症。该病例突出了一种常见疾病的两种罕见并发症，儿科急诊医护人员应认识到这一点，因为需要手术干预，否则可能会有长期后遗症。
