A student died of a brain abscess, secondary to an ear infection, after 14 days and 2 emergency visits at Edouard-Herriot hospital, in Lyon. This story raises the question of access to doctors in general and ENT specialists, what is called the “care path”.
At the beginning of February, Leana Bonilla Cruz, a 19-year-old Nicaraguan student in good health, who had been studying literature for six months in Lyon, felt severe pain in her ear. She went for the first time to the emergency room of the Édouard Herriot Hospital, in Lyon, on February 9, according to our colleagues from the Progress. The emergency room doctors send her home with painkillers and an antibiotic.
Three days later, faced with the persistence of pain and the onset of vomiting, she returned to the same emergency room, accompanied by her friends. She spends 8 hours there and the doctors send her home with another antibiotic treatment … noting that emergencies are not used to treat ear infections.
On February 21, after 12 days of suffering, she was transported in a coma to the Edouard-Henriot hospital in Lyon. She died there of intracranial hypertension secondary to a cerebral abscess, without the doctors having been able to do anything, a rare complication of otitis, which has hardly been seen in France since the advent. antibiotic treatments.
Rhône | Leana, 19, died of ear infections despite two emergency room visits https://t.co/qF8hezVubH pic.twitter.com/SEPauBRXrq
– Progress (@Le_Progres) March 10, 2018
How can you die from an ear infection?
Otitis is an infection of the outer ear (the ear canal) and especially the middle ear, which is located deep in the bone and behind the eardrum. Extremely frequent, ear infections have a slightly different causal mechanism in adults than in children, which requires careful ENT assessment.
Thanks to antibiotic therapy, in the vast majority of cases, adult otitis is a mild disease that heals without sequelae. However, an acute purulent otitis, poorly treated and “lingering”, can progress to a spread of the infection, first to the bone and this gives a “mastoiditis” (infection spread to a bone at the base of the skull. ) or to the brain and this results in “meningitis” (the envelopes of the brain) or a brain abscess, which is an abscess inside the brain.
Brain abscess causes numerous additional complications (thrombophlebitis in the brain) and intracranial hypertension, linked to swelling of the brain (abscess and cerebral edema) in a bony cranial box … and therefore inextensible. Brain death then occurs quickly if the abscess cannot be drained.
Emergencies in charge
The mother of the victim, who claims that her daughter suffered from severe headaches, recurrent vomiting and a discharge from the ear (all signs of complication), claims that her daughter was not listened to and denounces ” a medical error ”. She filed a complaint against the hospital for “manslaughter”.
According to the head of the emergency department, there would have been “no dysfunction” in the procedure set up in the emergency room. Even though Leana waited to see a doctor, she had seen a reception and guidance nurse within half an hour of her arrival, who applied the procedure in force (“sort 4”) and the “exams were strictly normal ”. He ensures that her temperature was normal and that she did not vomit during her visits to the emergency room (?) Contrary to what her friends say.
She should have seen a specialist
All good medical textbooks advise exploring ear infections in adults differently than in children, especially if the fever is over 40 ° C, there is purulent discharge from the ear, and there is severe headaches. In the present case, the last 2 criteria were present and his fever could have been partially masked by a non-steroidal anti-inflammatory drug (NSAID which could also have favored infectious dissemination).
Beyond coming to the emergency room for an ear infection, which may be linked to the fact that this young Nicaraguan student did not have an attending physician, a specialist ENT examination should have been carried out or scheduled, quickly or at least during the 12 days. before the final hospitalization, in particular during the 2nd visit, in the face of this prolonged and pejorative development.
According to the head of the emergency department, this consultation could not be organized. Of which act. But that’s probably the only thing that would have been helpful.
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