Do you recognize this triad?

May 09, 2018

Figure 1 Quiz of the Week

A 25-year-old male presents to the emergency department with headache, retro-orbital pain, and diplopia when gazing to the right. He had visited an urgent care clinic with right ear pain two weeks earlier and had received a short course of antibiotics. After some initial improvement, he became increasingly unwell before presenting today. Otoscopy reveals purulent discharge in the right ear canal and a CT scan demonstrates the findings seen here.

Which organism is most commonly responsible for this patient’s likely diagnosis?

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Image credit: @Oto-oto-rhino.


Answer: Pseudomonas aeruginosa

This patient’s findings are indicative of petrous apicitis, an infection of the petrous apex of the temporal bone, and a complication of otitis media. The condition is most often caused by Pseudomonas aeruginosa, and can present with retro-orbital pain, sixth nerve (lateral rectus) palsy, and otorrhea—a clinical triad known as Gradenigo’s syndrome. Treatment includes antibiotics targeting the offending organism, with surgical intervention typically reserved for infections associated with complications or that do not respond to the appropriate antibiotics.

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