Paediatric septic thrombophlebitis secondary to an otogenic infection: a single-centre retrospective case series.

Paediatric septic thrombophlebitis secondary to head and neck infections is a rare but life-threatening disease. Although commonly associated with oropharyngeal infections, otogenic cases have also been described, yet paediatric literature on their disease course and thrombotic distribution remains sparse. To describe the clinical presentation, thrombotic distribution, management, and outcomes of paediatric septic thrombophlebitis secondary to primary otogenic infections. We conducted a retrospective case series of children aged 0-18 years admitted to a tertiary paediatric referral centre between 2016 and 2021 with septic thrombophlebitis following an otogenic infection. Clinical, microbiological, radiological, and treatment data were extracted from records. Ten patients (median age 4.5 years, 70% male) were included. Most cases presented with primary acute otitis media and mastoiditis. Fusobacterium necrophorum was detected in 50% of cases. Internal jugular vein thrombosis occurred in 80%, sigmoid sinus thrombosis in 60%, and cavernous sinus thrombosis in 30%. All patients received systemic antibiotics and anticoagulant therapy for medians of 42.5 and 46 days, respectively. Surgery, mainly otogenic interventions, such as mastoidectomy, was performed in 90% of patients. Complications other than thrombosis occurred in 70% of cases and encompassed both intra- and extracranial manifestations. Thrombosis resolved or recanalized in 78% of cases on follow-up imaging.

conclusionThis case series adds to the limited literature on paediatric septic thrombophlebitis secondary to otogenic infections, highlighting a high rate of internal jugular vein thrombosis and a complicated disease course. WHAT IS KNOWN: • Paediatric thrombophlebitis secondary to an otogenic infections is a rare but life-threatening disease. • These otogenic presentations can be a diagnostic challenge, while carrying a signifi cant risk of severe intracranial or systemic complications. WHAT IS NEW: • This paediatric case-series describes the complicated disease course of septic thrombophlebitis following primary otogenic infections, demonstrating heterogeneity in clinical presentations and thrombotic distributions.