A Rare Case of Refractory Mycobacteroides Abscessus Otomastoiditis in an Immunocompetent Child: A Multidisciplinary Treatment Approach

This case report details a rare and severe presentation of refractory otomastoiditis caused by <i>Mycobacterium abscessus</i> in an immunocompetent pediatric patient who presented with a 1-month history of left ear pain, swelling, and fever unresponsive to antibiotics. Computed tomography imaging was suggestive of coalescent otomastoiditis, and she underwent urgent left mastoidectomy, subperiosteal abscess drainage, and myringotomy with tube insertion, followed by conventional antibiotic management. Despite these interventions, she remained symptomatic and cultures revealed <i>M. abscessus</i> 1 week later. <i>Multidisciplinary management involved serial microdebridement and prolonged multidrug antimicrobial therapy with shared decision-making between otolaryngology, infectious diseases, and international experts. Pharmacological management was complicated by adverse effects including aminoglycoside-induced hearing loss, myelosuppression, and gastrointestinal intolerance requiring drug substitutions. Eighteen months after initial presentation, revision mastoidectomy, canaloplasty, mastoid obliteration, tympanoplasty, and ossiculoplasty were performed for the eradication of residual disease and reconstruction. At follow-up, there was no disease recurrence although left-sided moderate-to-severe mixed hearing loss persisted. This case highlights the importance of early recognition and coordinated medical-surgical interventions in atypical presentations of mastoiditis.</i>