A Case of Acute Coalescent Mastoiditis With Early Diagnosis of Lupus Anticoagulant-Hypoprothrombinemia Syndrome Prompting Immediate Surgical Drainage

TL;DR

A young girl with severe mastoiditis and a coagulation disorder was successfully treated with timely surgery after careful risk evaluation.

Contribution

This case highlights the management of coalescent mastoiditis complicated by lupus anticoagulant-hypoprothrombinemia syndrome through rapid diagnosis and surgical intervention.

Findings

Surgical drainage was safely performed despite coagulation abnormalities.

Streptococcus intermedius and Fusobacterium nucleatum were identified as causative organisms.

Cross-mixing studies helped assess low bleeding risk before surgery.

Abstract

Acute coalescent mastoiditis is a severe complication of acute otitis media characterized by bone destruction in the mastoid process and a risk of serious complications such as abscess formation and intracranial spread. Prompt surgical management is often required, especially in cases with evidence of disease progression. We report the case of a four-year-old girl who developed acute coalescent mastoiditis complicated by transient lupus anticoagulant-hypoprothrombinemia syndrome (LAHPS). Despite initial antibiotic treatment, the patient’s symptoms worsened, and imaging revealed bone erosion in the mastoid region. Laboratory tests showed significantly prolonged activated partial thromboplastin time, raising concern for bleeding during surgery. A cross-mixing study and bleeding assessment revealed low bleeding risk, supporting the decision to proceed with surgical drainage and mastoidectomy. The procedure was completed safely, and cultures identified Streptococcus intermedius and Fusobacterium nucleatum as the causative organisms. This case highlights the importance of rapid diagnosis, careful evaluation of bleeding risk, and timely surgical intervention in managing coalescent mastoiditis, especially when complicated by coagulation abnormalities like LAHPS.

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