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Coexistent acute pyogenic and tubercular petrous apicitis: a diagnostic dilemma

Published online by Cambridge University Press:  14 March 2006

A Sethi ,
D Sethi ,
S Mrig ,
J C Passey  and
N Srivastav
A Sethi
Affiliation:
Departments of ENT & Head and Neck Surgery, Maulana Azad Medical College and associated L N Hospital, New Delhi, India
D Sethi
Affiliation:
Departments of ENT & Head and Neck Surgery, Maulana Azad Medical College and associated L N Hospital, New Delhi, India
S Mrig
Affiliation:
Departments of ENT & Head and Neck Surgery, Maulana Azad Medical College and associated L N Hospital, New Delhi, India
J C Passey
Affiliation:
Departments of ENT & Head and Neck Surgery, Maulana Azad Medical College and associated L N Hospital, New Delhi, India
N Srivastav
Affiliation:
Radiology, Maulana Azad Medical College and associated L N Hospital, New Delhi, India
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Abstract

We report the case of a 16-year-old boy who presented to us with acute otitis media, facial weakness and retro-orbital pain. Computed tomography and magnetic resonance imaging (MRI) scans of the head and temporal bone revealed otitis media with petrous apicitis. The patient responded to broad-spectrum, parenteral antibiotics, with disappearance of facial weakness and reduction in pain. One month following the completion of treatment, the patient continued to have dull retro-orbital pain and developed ear discharge. A repeat MRI of the temporal bone revealed a persistent inflammatory lesion in the petrous apex, with a nodular, ring-enhancing lesion in the cerebellum, strongly suggestive of tuberculosis. The ear discharge stained positive for acid-fast bacilli and the patient's serum enzyme-linked immunosorbent assay for tuberculosis was reactive. The patient responded well to anti-tubercular treatment and was disease free eight months following the completion of treatment.

Keywords

Petrous BoneOtitis MediaMastoiditisTuberculosis
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 120 , Issue 10 , October 2006 , pp. 875 - 878
Copyright
2006 JLO (1984) Limited

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