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      Gradenigo's Syndrome and Bacterial Meningitis in a Patient with a Petrous Apex Cholesterol Granuloma

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          Abstract

          Gradenigo's syndrome (GS) classically involves a triad of ear pain due to acute or chronic otitis media (OM), facial or retro-orbital pain in the distribution of the trigeminal nerve, and an abducens nerve palsy. The simultaneous presentation of all three components has become less common in cases of GS reported in the literature, particularly in the era of antibiotics effective against typical organisms attributed to OM and petrous apicitis. In addition to infectious petrous apicitis arising directly from OM, more recent cases of GS are attributed to the compression of the same traversing cranial nerves in the presence of various expansile petrous apex (PA) lesions, both benign and malignant. We report a case of a 24-year-old male who presented initially with nausea, fever, photophobia, left-sided retro-orbital pain, and headache. He was diagnosed with bacterial meningitis by lumbar puncture and treated with empiric antibiotics, with CSF eventually revealing nontypeable Haemophilus influenzae. Several days into his course, he developed diplopia with leftward gaze. Brain imaging revealed an expansile, erosive PA cholesterol granuloma with associated contiguous dural and leptomeningeal enhancement. The patient improved with antibiotics and eventually underwent surgical intervention. This atypical presentation of GS with a rare complication of meningitis in the setting of a PA granuloma demonstrates the importance of early recognition of this syndrome, as well as consideration of added surgical intervention in patients with pre-existing petrous lesions at potentially higher risk of dangerous complications of GS.

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          Most cited references26

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          Pathogenesis of bacterial meningitis: from bacteraemia to neuronal injury.

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            Invasive Disease Caused by Nontypeable Haemophilus influenzae

            These infections are emerging worldwide, especially in young children and the elderly.
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              The changing face of petrous apicitis-a 40-year experience : The Changing Face of Petrous Apicitis

              Petrous apicitis (PA) is a rare complication of otitis media. Gradenigo syndrome, with the classic triad of otitis, deep pain, and abducens paralysis, is rarer still. The objective of this study was to determine if clinical presentation and management has changed over time.
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                Author and article information

                Contributors
                Journal
                Case Rep Infect Dis
                Case Rep Infect Dis
                CRIID
                Case Reports in Infectious Diseases
                Hindawi
                2090-6625
                2090-6633
                2020
                20 October 2020
                : 2020
                : 8822053
                Affiliations
                1Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, USA
                2Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, USA
                3Department of Pathology, University of Virginia, Charlottesville, USA
                Author notes

                Academic Editor: Larry M. Bush

                Author information
                https://orcid.org/0000-0001-9879-7502
                https://orcid.org/0000-0001-7905-1481
                https://orcid.org/0000-0003-3252-3001
                Article
                10.1155/2020/8822053
                7593741
                33133707
                3b76e1bc-b9ac-4b9c-81ca-d28084b0a8dd
                Copyright © 2020 Jacqueline Hodges et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 16 April 2020
                : 8 October 2020
                Categories
                Case Report

                Infectious disease & Microbiology
                Infectious disease & Microbiology

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