The relentless right ear pain: A case report

Fusobacterium necrophorum is an anaerobic gram-negative rod commonly found in humans' gastrointestinal and respiratory tracts. While classically associated with Lemierre's syndrome, F. necrophorum can cause pharyngitis, sinusitis, and otitis, especially in young adults. On rare occasions, it can progress to lifethreatening complications including meningitis, intracranial abscess, and sinus thrombosis. Case Report-An adolescent presented multiple times in one week for persistent right ear pain. Despite treatment, the patient continued to worsen and presented to the emergency department after developing fever, lethargy, and vomiting. Lumbar puncture confirmed meningitis with over 250 white blood cells x10∼3/UL. The patient was transferred to a children's hospital, where cavernous sinus thrombosis was also identified. The patient underwent mastoidectomy and started on heparin intravenously. Upon discharge, he transitioned to enoxaparin and later rivaroxaban for three months. Why should an emergency physician be aware of this? Fusobacterium necrophorum is a rare cause of otitis and meningitis but can be deadly if not treated appropriately. As a gram-negative anaerobe, standard meningitis treatment does not adequately treat this organism. Significant morbidity and mortality are associated with this disease.