Temporal Lobe Abscess Secondary to Chronic Otitis Media: Evaluation and Management in a Medical Complex Patient

Chronic otitis media is a persistent middle ear infection caused by various well-described bacteria that, in rare cases, can lead to severe complications including intracranial infections such as brain abscesses and meningitis. We present a case of a 42-year-old female with a complicated medical history including chronic otitis media, who developed a brain abscess and meningitis following the spread of the infection. The patient initially presented with altered mental status and concerns for acute intracranial processes were confounded by her significant polysubstance use history. Further work up revealed bacteremia. Imaging revealed middle ear effusions with skull base dehiscence and a large brain abscess in the temporal lobe. Workup revealed a diagnosis of viral and bacterial meningitis via blood, and CSF cultures from both cerebrospinal fluid and ear discharge confirmed the presence of <i>Streptococcus pneumoniae</i> with Epstein-Barr Virus (EBV) DNA in the CSF. The patient was treated with intravenous antibiotics, surgical drainage of the abscess, and supportive care, leading to clinical improvement and eventual discharge from the hospital against medical advice. This case highlights the potential for chronic otitis media to result in life-threatening intracranial infections, underscoring the importance of early detection, high clinical suspicion despite patient confounding medical factors, and aggressive management in cases of advanced disease.