Coexistent acute pyogenic and tubercular petrous apicitis: a diagnostic dilemma.
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.
Sethi
A
A
Department of ENT, Maulana Azad Medical College and associated L N Hospital, New Delhi, India. dr_sethi@rediffmail.com
Sethi
D
D
Mrig
S
S
Passey
J C
JC
Srivastav
N
N
D000293:Adolescent; D003937:Diagnosis, Differential; D005158:Facial Paralysis / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010035:Otitis Media, Suppurative / Q000175:diagnosis / Q000188:drug therapy; D010579:Petrous Bone; D014057:Tomography, X-Ray Computed; D014394:Tuberculosis, Osteoarticular / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy