Bezold’s Abscess: A Case Report and Review of Cases Over 20 Years

Abstract

Bezold's abscess (BA) is a severe and rare extracranial complication of suppurative acute mastoiditis. The diagnosis of BA requires a high index of suspicion due to its rarity. In this study, we present a rare case of BA, in addition to a review of literature over 20 years. We searched for all cases in English literature from 2000 to 2020 in PubMed and found 27 cases (28 cases including the current case). BA was more prevalent in males (17/28, 60.7%) and adults (17/28, 60.7%). Of the 28 cases, six were associated with cholesteatoma and another six cases occurred with concomitant sinus thrombosis.

Uncommon Find: An Unusual 10 cm Bezold's Abscess Involving Dural and Mastoid Erosion

“…In this case report, we highlight a BA, a rare suppurative extracranial complication of acute otitis media, with a diameter of 10 cm with partial compression of the left jugular veins as well as the transverse and sigmoid sinuses. Between 2000 and 2020, 28 cases of BA were published on PubMed [ 5 ]. The majority of the reported cases measured 6 cm or smaller, and only one case reported an abscess diameter of 10 cm, highlighting the rarity of this size [ 5 ].…”

“…Between 2000 and 2020, 28 cases of BA were published on PubMed [ 5 ]. The majority of the reported cases measured 6 cm or smaller, and only one case reported an abscess diameter of 10 cm, highlighting the rarity of this size [ 5 ]. Depending on the extent of BA, multiple head and neck structures might be compressed, leading to further complications in the patient, making a 10 cm abscess highly problematic.…”

“…Depending on the extent of BA, multiple head and neck structures might be compressed, leading to further complications in the patient, making a 10 cm abscess highly problematic. Thorough evaluation of patient history and symptomatology are crucial in patients presenting with otitis media and mastoiditis as BA often develops behind the neck muscles, presenting a challenge for detection through a neck examination [ 3 , 5 ]. Common indicators of BA include progressive fever, neck swelling, facial paralysis, neck pain, otorrhea, hearing loss, and ear pain [ 6 ].…”

“…Common indicators of BA include progressive fever, neck swelling, facial paralysis, neck pain, otorrhea, hearing loss, and ear pain [ 6 ]. Laboratory workup, along with physical exam and history, is often supportive in the diagnosis of BA, as there is usually elevated leukocyte count and erythrocyte sedimentation rate [ 5 ]. CT scan is the imaging modality of choice in patients with BA as it allows visualization of the extent of the abscess and involvement of the mastoid process and adjacent affected structures [ 3 ].…”

“…Besides the administration of antibiotics, surgical mastoidectomy, debridement, and drainage are often necessary for the resolution of the abscess and to prevent additional complications. Of the 28 patients with data regarding treatment, current measures reduce the possibility of further expansion of BA, leading to associated complications.Streptococci are the most common causative organisms of BA reported in the literature [ 5 ].…”