Cholesteatoma Complicated by a Cerebral Abscess and Pyoventriculitis: “Spreading Like Wildfire”

Cholesteatoma, an abnormal accumulation of keratinized squamous epithelium in the middle ear, is a locally invasive but histologically benign lesion whose silent progression can lead to serious intracranial complications. Although these complications related to chronic cholesteatoma of the middle ear have become rare, they still carry a high mortality rate. This case report presents the rare observation of a cholesteatoma complicated by a brain abscess and pyoventriculitis in a 25-year-old patient, highlighting the crucial role of MRI, particularly diffusion-weighted and FLAIR sequences, in the diagnostic process. Despite multidisciplinary management combining antibiotic therapy and surgery, the outcome was fatal, illustrating the extreme severity of abscess rupture in the ventricular system.