CASE REPORT   

Otorinolaringologia 2019 June;69(2):119-21

DOI: 10.23736/S0392-6621.18.02190-2

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

What is the correct therapy for a petrositis? A critical point of view starting from a case report in a child

Luca PECORARO ¹ ✉, Giovanna LA FAUCI ¹, Patrizia LO TARTARO MERIGLIOTTA ¹, Giuseppe PAGANO ², Davide SILVAGNI ¹, Paolo BIBAN ²

¹ Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy; ² Unit of Pediatric Intensive Care, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy

This article describes a rare case of petrositis, an intratemporal complication of acute otitis media, caused by the extension of the infectious process into the cells of the petrous portion of the temporal bone. A 5-year-old boy presented with history of fatigue, loss of appetite, headache, vomiting, right eye ptosis, ataxic march and positive Romberg test: these signs and symptoms had been worsening for 2 weeks. Blood tests showed mild increase in C-reactive protein (CRP), the other tests were negative. CT scan of petrous temporal bone and brain MRI showed an important inflammatory involvement of the apex of the right petrous of the temporal bone with involvement of the base of the clivus and ipsilateral cavernous sinus. The child was started on parenteral antibiotic and antiviral therapy associating intravenous corticosteroid in order to limit the inflammatory edema. Petrositis has traditionally been treated with aggressive surgical methods. As opposed to this approach, this case report confirms recent findings of the literature, which have documented good results with more conservative therapy with high-dose broad-spectrum antibiotics.

KEY WORDS: Petrositis - Ataxia - Otitis media - Anti-infective agents - Conservative treatment