Department of Otolaryngology and Head and Neck Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
Tokai J Exp Clin Med. 2023 Jul 20;48(2):72-77.
Bezold's abscess is an extracranial complication of otitis media, in which a cervical abscess forms from the mastoid process through an ostial fistula, and is a rare condition in recent years. In this study, we experienced a X-linked agammaglobulinemia, which was discovered due to Bezold's abscess. Case: A 12-year-old boy suffering from recurrent right suppurative otitis media for three months was treated with tympanostomy and oral antibacterial therapy at a local otorhinolaryngology clinic. The patient visited the clinic due to a recurrence of symptoms. CT showed bony defects in the cortical bone and mastoid process of the lateral side of the right mastoid cell. The patient was referred to our hospital, admitted the same day and underwent emergency surgery. Intraoperative findings led to the diagnosis of acute mastoiditis and Bezold's abscess c aused b y mastoiditis spreading to the s ternocleidomastoid muscle. After drainage and administration of ABPC/SBT, the abscess disappeared, and the patient's general condition improved. Subsequently, a blood typing test performed on admission suggested the influence of low immunoglobulin levels. A close examination by the pediatric department led to a diagnosis of X-linked agammaglobulinemia. As a result, the patient receives regular immunoglobulin therapy and has been free of infection, including Bezold's abscess. CONCLUSIONS: In the case of recurrent otitis media and rare infections, congenital immune abnormalities should be considered.
贝佐尔德脓肿是中耳炎的一种颅外并发症，其中乳突通过口窦瘘形成颈部脓肿，近年来是一种罕见的疾病。在本研究中，我们遇到了一例 X 连锁无丙种球蛋白血症，该病是由于贝佐尔德脓肿而被发现的。病例：一名 12 岁男孩因反复发作性右侧化脓性中耳炎，在当地耳鼻喉科诊所接受了鼓膜切开术和口服抗菌治疗。由于症状复发，患者就诊于诊所。CT 显示右侧乳突细胞外侧皮质骨和乳突骨有骨缺损。患者被转至我院，当天入院并接受了急诊手术。术中发现导致急性乳突炎和贝佐尔德脓肿的原因是乳突炎向胸锁乳突肌扩散。引流和 ABPC/SBT 给药后，脓肿消失，患者一般情况改善。随后，入院时进行的血型检查提示免疫球蛋白水平低下的影响。儿科的进一步检查导致 X 连锁无丙种球蛋白血症的诊断。因此，患者接受了定期的免疫球蛋白治疗，并且没有发生感染，包括贝佐尔德脓肿。结论：对于反复发作的中耳炎和罕见感染，应考虑先天性免疫异常。
