Imaging Clinic: Destructive Temporal Bone Osteomyelitis in an Infant—CT and 3D Findings

Acute mastoiditis is a recognized intratemporal complication of acute otitis media in children, but progression to frank temporal bone osteomyelitis with extensive cortical necrosis is exceptionally rare in infancy. This report presents a 1-year-old infant with refractory acute mastoiditis complicated by destructive temporal bone osteomyelitis. High-resolution computed tomography with 3D reconstruction demonstrated extensive cortical loss. Emergency subtotal mastoidectomy and radical debridement were performed. Deep intraoperative culture yielded multidrug-resistant Staphylococcus hominis, and histopathology confirmed osteomyelitis. The child improved rapidly on targeted linezolid therapy and completed a 4-week course with complete clinical and laboratory resolution. This case highlights the importance of early imaging, deep tissue sampling, and targeted therapy in rare infant temporal bone osteomyelitis.