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Gonçalo Padeira1, Rita Ferreira2, Flora Candeias1, Herédio de Sousa2, Catarina Gouveia1, Maria João Brito1

1 - Unidade de Infecciologia Pediátrica, Pediatria Médica Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisboa
2 - Unidade de Otorrinolaringologia Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisboa

- Reunião internacional, poster
- 35th Annual Meeting of the European Society for Paediatric Infectious Diseases 2017

Introduction: Fusobacterium necrophorum is a non spore forming anaerobe usually found in the oropharynx as part of the normal flora. It has an infrequent cause of acute otitis and mastoiditis in young patients. Meningitis and cerebral abscesses are very rare and can have devastating effects.
Case Report: We present the case of a 2 year-old girl with a otitis media with a facial palsy. She started ceftriaxone and underwent a miringotomy. After three days she presented meningeal signs. The lumbar puncture showed 62149 leucocytes with 11,0 mg/dL glucose and 92,3 mg/dL proteins. The cultural exam was negative. A MRI-CT revealed a otomastoiditis and a epidural abscess. She underwent a mastoidectomy and started vancomicine and ceftriaxone. She was discharge with a residual facial weakness and hearing impairment. At follow-up, 1 month later, the CT revealed an important destruction of the mastoid associated with an exuberant bony labyrinth osteitis. Clinically she still maintained hearing impairment. Bacterial DNA in the liquor showed Fusobacterium necrophorum. She returned to the OR for cleaning of the inner ear and also started amoxiciline plus clavulanic acid. One month later the patient recovered part of her facial movements and new MRI and CT showed an improvement of the inflammatory process
Comments: Fusobacterium necrophorum is an emergent agent. This infection, when arising from the ear, seems to affect a younger age group and have a much higher rate of intracranial complications. It can bring about the rapid destruction of one of the most dense bones of the human body. This case shows the remarkable ability of the paediatric brain to overcome the impressive destruction of the inner ear as our patient recovered her facial movements although not her hearing.

Palavras Chave: facial palsy, Fusobacterium, mastoiditis, meningitis