OBJECTIVE: To report a case with cholesteatoma, which evolved into a cerebral abscess and resulted in subsequent death. Report: A 47-year-old white man was born in Jaú - SP and came from Marília-SP, Mason. He had cholesteatoma of the middle ear and did not follow up. He presented at the emergency room complaining of otorrhea in his left ear, left temporal headache, fever, dizziness, and confusion for the past 3 days. Physical examination revealed drowsiness, disjointed words, and fetid otorrhea in the left ear. Magnetic resonance imaging of the skull revealed an extensive brain abscess in the left temporal lobe and cerebritis signals. He was started on ceftriaxone, oxacillin, metronidazole, dexamethasone, and mannitol. The brain abscess was drained using the classical neurosurgical approach (craniotomy). The patient died 2 days after the procedure. CONCLUSION: Cerebral abscess is one of the most serious complications of cholesteatoma for patients with this condition for long periods of time.