Bilateral Cavernous Sinus Thrombosis and Clival Osteomyelitis Complicating Pediatric Otitis Media

Central skull base osteomyelitis (SBO) and associated neurovascular complications represent critical clinical conditions that necessitate prompt diagnosis and aggressive therapeutic intervention. We report the case of a previously healthy four-year-old boy who presented with a six-day history of purulent left otorrhea, fever, headaches, and the acute onset of left convergent strabismus. Contrast-enhanced CT revealed left-sided acute otitis media complicated by bilateral cavernous sinus thrombosis, right ophthalmic vein thrombosis, left sigmoid sinus and internal jugular vein thrombosis, and an associated subperiosteal orbital abscess. Concurrently, extensive clival osteolysis confirmed a diagnosis of central SBO. The patient was successfully managed with an aggressive therapeutic protocol comprising targeted high-dose antibiotics and anticoagulation, leading to complete clinical and laboratory recovery. This case emphasizes the necessity of immediate advanced neuroimaging when cranial nerve deficits accompany a routine pediatric ear infection and for prompt initiation of dual antimicrobial and anticoagulant therapy to avert catastrophic outcomes.