The paper presents a case of acute mastoiditis with atypical presentation, characterized by high fever, painful oedema in the temporo-mandibular region and disability in opening the mouth. Pain was exacerbated by exerting pressure on the temporal bone. Otoscopy was normal, with unharmed postauricular region. A history of recent acute media otitis or trauma was denied. Imaging allowed the diagnosis of acute mastoiditis with temporal myositis and osteitis, focal meningitis and intra-extracranial abscess.
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