Metastatic Pancreatic Adenocarcinoma Manifesting as Otomastoiditis and Collet–Sicard Syndrome

Otomastoiditis is not prevalent in immunocompetent adults and in some cases can be caused by insidious malignancies of the temporal bone. Collet–Sicard syndrome (CSS) is a constellation of symptoms associated with unilateral lower cranial nerve deficits that can occur in the setting of radiologically elusive temporal bone malignancies. We present a rare case of an adult man with temporal bone biopsy–confirmed pancreatic cancer that initially presented with otomastoiditis and CSS. This case demonstrates how malignancy should remain a top differential diagnosis for clinicians who encounter immunocompetent adults with otomastoiditis, even when unsupported by advanced imaging modalities.