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Luís Rodrigues1,2, Flora Candeias1, Sara Rocha3, Rosário Faustino4, Maria João Brito1

1 - Infectious Diseases Unit, Hospital de Dona Estefânia Centro Hospitalar de Lisboa Central, Lisboa, Portugal
2 - Department of Pediatrics, Hospital do Espírito Santo de Évora, EPE, Portugal
3 - Department of Pediatrics, Hospital de Santarém, EPE, Portugal
4 - Department of Otorhinolaryngology, Hospital de Santarém, EPE, Portugal

- 65 Congreso de la AsociaciónEspañola de Pediatria. Santiago de Compostela, 1 a 3 de Junho de 2017.
- Apresentação em poster e publicação sob a forma de resumo

Introduction: Biological, psychological and social factors exist along a continuum of natural systems. In this case report we emphasize the importance of understanding human health and illness in their fullest contexts and the need of a close follow-up.
Case presentation: A 17-year-old male with a history of epilepsy and multiple seizures due to poor compliance, behavioral changes, attention deficit disorder and learning difficulties previously seen in the psychiatry clinic, discharged two years ago. He also had obesity (BMI 32 kg/m2) and recurrent otitis media.Three weeks before admission, he was diagnosed with acute otitis media and treated with amoxicillin / clavulanic acid and subsequently flucloxacillin. However he did not comply with treatment. Two weeks later he was hospitalized for treatment of otitis. Proteus mirabilis was isolated in the auricular exudate and was given ceftriaxone and metronidazole. On day 8 of admission he complained of headache, vomiting and fever. Slight papilledema was noted, with normal neurological examination. CT revealed otitis media with cholesteatoma and signs suggestive of thrombophlebitis of the sigmoid sinus. CT angiography revealed abscess from the posterior fossa and confirmed thrombosis of the sigmoid sinus. He was treated with piperacillin+tazobactam, amikacin and metronidazole and enoxaparin and restarted levetiracetam. The study of thrombophilias did not show any abnormalities. The clinical picture was improving, but on day 13 of admission there was a decompensation of the psychiatric pathology, with aggressiveness, loss of insight and refusal to comply with treatment requiring paliperidone and psychiatry intervention and follow-up.Only after the patient was stable from the psychiatric point of view did he undergo tympanoplasty and mastoidectomy with no complications. Since then there have been no more infectious or neurological episodes and he is being regularly followed up in clinic.
Comments: In this patient the absence of regular and structured psychiatric and social follow-up has led to serious complications of acute otitis media, a very common pathology in pediatrics. We believe this also contributed to a poorly controlled epilepsy and severe obesity. This case demonstrates that the patient should be evaluated and seen as a whole and reinforces the importance of a bio-psycho-social approach.

Palavras Chave: Abscess; Cholesteatoma; Complications; Follow-up; Thrombophlebitis