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Clin Exp Emerg Med > Volume 11(2); 2024 > Article
Tillett and Anderson: Bezold abscess in a 4-year-old: an exceptionally rare complication of otitis media
A 4-year-old male patient presented to the emergency department with 2 days of low-grade fever and neck stiffness. He was sent to the emergency department by his pediatrician with initial concern for meningitis. The child had not complained of photophobia or ear or throat pain. Prior to lumbar puncture, CT of the head and neck identified bilateral otomastoiditis and a Bezold abscess (Fig. 1). The patient underwent urgent abscess drainage and mastoidectomy and was admitted to the pediatric intensive care unit. The child was discharged home with antibiotics after several days, ultimately making a full recovery.
A Bezold abscess is an exceptionally rare complication of untreated acute otitis media or mastoiditis, with only about 100 cases described in the English literature and only four reports in children younger than 5 years [1]. Bezold abscesses occur when an infection in the mastoid space erodes through the bony cortex and into the deep spaces of the neck [2]. The infection can spread to the carotid sheath, mediastinum, and brain with devastating consequences if source control is not promptly obtained [2]. Urgent intervention with antibiotics and surgical drainage is required to prevent disease progression and death. While exceptionally rare in the modern age due to the widespread use of antibiotics, emergency physicians must consider this diagnosis in children presenting with neck pain, as failure to identify this late complication can have devastating consequences.

Ethics statement

Informed consent was waived due to the retrospective nature of the study.


Author contributions
Conceptualization: all authors; Investigation: all authors; Supervision: RA; Writing–original draft: all authors; Writing–review & editing: all authors. All authors read and approved the final manuscript.
Conflicts of interest
The authors have no conflicts of interest to declare.
The authors did not receive financial support for this study.
Data availability
Data sharing is not applicable as no new data were created or analyzed in this study.


1. Winters R, Hogan CJ, Lepore ML, Geiger Z. Bezold abscess [updated 2023 Jul 4]. In: StatPearls [Internet]. StatPearls Publishing; [cited 2023 Mar 20]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK436004/.

2. Sahi D, Nguyen H, Callender KD. Mastoiditis [updated 2023 Aug 8]. In: StatPearls [Internet]. StatPearls Publishing; [cited 2023 Mar 20]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560877/.

Fig. 1.
Computed tomography scan of Bezold abscess. (A) The coronal view. The arrow indicates the Bezold abscess. (B) The zoomed-in view.
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