3-Year-Old Female Patient Admitted to ER with Fever and Vomiting

Case Summary

• 3-year-old female patient, born and raised in São Paulo, Brazil
• Previously healthy
• Admitted to E.R. with a 2-d history of fever and vomiting
• Right Otitis Media diagnosed in another service, treated with azithromycin.
• Developed with worsening of symptoms and bilateral convergent strabismus, more accentuated to the right

PHYSICAL EXAM

• Alert, fully conscious, oriented as to time and place
• Right tympanic membrane with signs of inflammation
• Bilateral convergent strabismus, more accentuated to the right

TREATMENT

• Ceftriaxone 100mg/kg
• Right Mastoidectomy
• Anticoagulation using 
• Unfracionated Heparin (UFH)
• No complications