Sequelae of Scarlet Fever: Involving Temporal Bones, Paranasal Sinuses, Meninges, and Lateral and Cavernous Sinuses, With New Bone Formation in Jugular Bulb

Abstract

The case reported here is recorded because it presented symptoms of every intracranial involvement known to complicate infection of the ear, nose and throat. The pathologic study of the temporal bones and of a block from the sphenoid bone revealed : thrombosis of the lateral and cavernous sinuses ; abscess of the carotid artery ; labyrinthitis ; petrositis, with extension to the meninges, and organization, with new bone formation blocking the jugular bulb. REPORT OF A CASEH. C., aged 6 years, entered the St. Louis Children's Hospital five days after the onset of an acute infection of the ears, nose and throat complicating scarlet fever. He had had earache, severe sore throat and vomiting, with high fever at the onset. The past history was irrelevant, except for mumps at 4 years of age and frequent colds in the head. Physical examination revealed a stuporous, poorly nourished child with marked acidosis and anhydremia. The respirations were deep and pauseless ; the pulse, rapid, and the temperature 39 C. (102.2 F.). The carbon dioxide-combining power was 18 volumes per cent. The white cell count was 45,000, with a differential count of 10 stab cells, 78 segmented cells and 4 lymphocytes. The chest was clear. The urine showed albumin (2+) with gran¬ ular and cellular casts. The Addis count showed red and white blood cells and granular and hyaline casts. There was a generalized acute infection qf the nasal membrane, nasopharynx and tonsils, with profuse nasal and postnasal discharge. The left ear was full of pus. The membrana tympani was red and full, with a central perforation. The right membrana tympani was thick, red and full. Myringotomy showed pus under pressure. A blood culture was negative. Cul¬ tures from the nose and throat showed streptococci. A culture from the right ear showed a few hemolytic streptococci and many hemolytic Staphylococcus aureus organisms ; that from the left ear, many hemolytic Staph. aureus organisms. Acidosis was controlled by the intravenous and subcutaneous injections of mole¬ cular sodium lactate. The patient was given frequent intravenous and subcutaneous injections of dextrose and lactate Ringer's solution devised by Dr. Hartmann. The