臨床
妊娠後期に発症し保存的治療で治癒が得られたGradenigo症候群例
2022 年 115 巻 6 号 p. 477-484
詳細
2022 年 115 巻 6 号 p. 477-484
Gradenigo syndrome is characterized by the triad of otitis media, trigeminal neuralgia, and abducens nerve palsy, and occurs most often when infection travels from the middle ear spreads to the petrous apex. With advances in diagnostic imaging and appropriate use of antibiotics, this syndrome is rarely seen nowadays. Herein, we report a case of Gradenigo syndrome that occurred in the third trimester of pregnancy and was successfully treated conservatively.
The patient was a 36-year-old woman who presented with the complaint of pain in her left ear and was diagnosed as having otitis media. She underwent left myringotomy at a local otolaryngology clinic and was started on treatment with oral cefditoren pivoxil. Her symptoms did not improve, and she developed diplopia. At the time of her initial visit to us, she was in the ninth month of pregnancy. She had a left ocular abduction disorder, otorrhea in the left ear, and redness and swelling of the tympanum. Detailed imaging examinations, including contrast-enhanced computed tomography, magnetic resonance imaging, and magnetic resonance angiography, revealed left otitis media, sphenoiditis, left petrositis, and left internal carotid artery occlusion due to the spread of inflammation. The patient was hospitalized, a repeat left myringotomy was performed and intravenous ceftriaxone was initiated at 4 g/day, along with ofloxacin eardrop instillation and tympanic cavity irrigation.
Many of the patient’s symptoms resolved in response to this treatment. She was discharged 41 days after admission and gave birth without incident. Later examinations showed bone regeneration in the left petrous apex and disappearance of the sphenoid sinus mucosal thickening.
Proper selection of tests and treatments was difficult prior to delivery in the present case, because of the need to consider their effects on the mother and the fetus. Management of this patient underscored to us the difficulty in managing severe infections during the perinatal period.
