{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T01:37:26Z","timestamp":1792201046290,"version":"4.4.0"},"reference-count":16,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,9,28]]},"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:p>Gradenigo-Lannois syndrome or petrous apicitis is an uncommon but a morbid complication of otitis media. Traditionally treated by surgery, recent advances in imaging and antibiotics have favoured a more conservative approach. Although pyogenic organisms are the leading aetiological agent, petrous apicitis due to Koch\u2019s bacilli is not rare. We report two cases of tubercular petrositis presenting as Gradenigo\u2019s syndrome with triad of ear discharge, deep-seated retro-orbital pain and diplopia. The first patient represented a mixed infection with pyogenic organism and tuberculosis, which was successfully treated with antibiotics and antitubercular therapy. The second patient showed an acute presentation of Gradenigo\u2019s syndrome with chronic otitis media having contact with an active tuberculosis case and showed dramatic response with antitubercular treatment. Tubercular petrous apicitis must be suspected and diagnosed promptly as only specific treatment will lead to symptomatic resolution and avoid complications.<\/jats:p>","DOI":"10.1136\/bcr-2020-236779","type":"journal-article","created":{"date-parts":[[2020,11,2]],"date-time":"2020-11-02T16:05:33Z","timestamp":1604333133000},"page":"e236779","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Unusual manifestation of Koch\u2019s disease: Gradenigo-Lannois syndrome"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3829-9872","authenticated-orcid":false,"given":"Aswin","family":"Chandran","sequence":"first","affiliation":[{"name":"Otorhinolaryngology & Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5590-9279","authenticated-orcid":false,"given":"Prem","family":"Sagar","sequence":"additional","affiliation":[{"name":"Otorhinolaryngology & Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rabia","family":"Monga","sequence":"additional","affiliation":[{"name":"Otorhinolaryngology & Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuchita","family":"Singh","sequence":"additional","affiliation":[{"name":"Otorhinolaryngology & Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,11,2]]},"reference":[{"key":"2025082623551398000_13.11.e236779.1","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1007\/BF01930369","article-title":"\u00dcber die Paralyse des Nervus abducens bei otitis","volume":"74","author":"Gradenigo","year":"1907","journal-title":"Archiv f. Ohrenheilkunde"},{"key":"2025082623551398000_13.11.e236779.2","doi-asserted-by":"crossref","first-page":"21","DOI":"10.3109\/09273972.2015.1130067","article-title":"The forgotten syndrome? four cases of Gradenigo's syndrome and a review of the literature","volume":"24","author":"Jensen","year":"2016","journal-title":"Strabismus"},{"key":"2025082623551398000_13.11.e236779.3","doi-asserted-by":"publisher","DOI":"10.1159\/000360413"},{"key":"2025082623551398000_13.11.e236779.4","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215113000315"},{"key":"2025082623551398000_13.11.e236779.5","doi-asserted-by":"publisher","DOI":"10.1016\/0090-3019(84)90011-9"},{"key":"2025082623551398000_13.11.e236779.6","doi-asserted-by":"crossref","first-page":"456c","DOI":"10.1136\/bjo.82.4.456c","article-title":"Intracranial plasmacytoma masquerading as Gradenigo's syndrome","volume":"82","author":"Bourne","year":"1998","journal-title":"Br J Ophthalmol"},{"key":"2025082623551398000_13.11.e236779.7","first-page":"bcr0820114723","article-title":"Embryonic rhabdomyosarcoma presenting as Gradenigo's syndrome","volume":"2012","author":"Ricks","year":"2012","journal-title":"Case Reports"},{"key":"2025082623551398000_13.11.e236779.8","doi-asserted-by":"crossref","first-page":"1152","DOI":"10.4103\/0973-1482.189223","article-title":"Recurrent petrositis due to nasopharyngeal carcinoma in an adult patient: Gradenigo's syndrome","volume":"14","author":"Aksoy","year":"2018","journal-title":"J Cancer Res Ther"},{"key":"2025082623551398000_13.11.e236779.9","doi-asserted-by":"crossref","DOI":"10.1186\/1752-1947-8-217","article-title":"Gradenigo's syndrome secondary to chronic otitis media on a background of previous radical mastoidectomy: a case report","volume":"8","author":"Plodpai","year":"2014","journal-title":"J Med Case Rep"},{"key":"2025082623551398000_13.11.e236779.10","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.amjoto.2010.07.018","article-title":"Acute otitis media-induced petrous apicitis presenting as the Gradenigo syndrome: successfully treated by ventilation tube insertion","volume":"32","author":"Kong","year":"2011","journal-title":"Am J Otolaryngol"},{"key":"2025082623551398000_13.11.e236779.11","first-page":"284","article-title":"[Gradenigo syndrome and cavernous sinus thrombosis in fusobacterial acute otitis media]","volume":"133","author":"Hananya","year":"1997","journal-title":"Harefuah"},{"key":"2025082623551398000_13.11.e236779.12","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1097\/WNO.0b013e3181c5d0fd","article-title":"Diffusion-Weighted MRI identifies petrous apex abscess in Gradenigo syndrome","volume":"30","author":"Ibrahim","year":"2010","journal-title":"J Neuroophthalmol"},{"key":"2025082623551398000_13.11.e236779.13","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1002\/lary.26571","article-title":"The changing face of petrous apicitis-a 40-year experience","volume":"128","author":"Gadre","year":"2018","journal-title":"Laryngoscope"},{"key":"2025082623551398000_13.11.e236779.14","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215100117797"},{"key":"2025082623551398000_13.11.e236779.15","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1017\/S0022215106000843","article-title":"Coexistent acute pyogenic and tubercular petrous apicitis: a diagnostic dilemma","volume":"120","author":"Sethi","year":"2006","journal-title":"J Laryngol Otol"},{"key":"2025082623551398000_13.11.e236779.16","first-page":"1039","article-title":"Taklal singh N, Falcone F,Velayudhan V. Gradenigo\u2019s syndrome in a patient with chronic suppurative otitis media, petrous apicitis, and meningitis","volume":"28","year":"2017","journal-title":"Am J Case Rep"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-236779","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T06:55:23Z","timestamp":1756277723000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-236779"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11]]},"references-count":16,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2020,11,2]]},"published-print":{"date-parts":[[2020,11]]}},"alternative-id":["10.1136\/bcr-2020-236779"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-236779","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11]]}}}