(A915) Complicated Petrous Apicitis in a Pediatric Patient with Type 1 Diabetes Mellitus: A Case Report

Introduction: Petrous apicitis (PA) is a rare complication of otitis media, often presenting with an incomplete Gradenigo’s triad and cranial nerve (CN) deficits. According to a systematic review conducted by Talmor et al., there is a lack of a multidisciplinary model for managing PAs, particularly for pediatric patients with type 1 diabetes mellitus (T1DM), contributing to the complexity of managing these rare cases.

Methods: We reviewed the electronic medical record of one patient admitted to the Children’s Hospital of the King’s Daughters.

Results: Herein, we describe a 17-year-old male with poorly managed T1DM admitted for diabetic ketoacidosis. He subsequently developed right-sided facial weakness, ear fullness, and odynophagia. Examination revealed right oropharyngeal fullness, middle ear effusion, and facial palsy. Imaging demonstrated inflammatory changes in the right pharyngeal, parapharyngeal, and retropharyngeal soft tissue spaces. Peritonsillar needle aspiration, formal incision and drainage of the right peritonsillar and retropharyngeal spaces, and right tympanostomy tube placement were performed. Despite these procedures and broad-spectrum antibiotics, he developed headaches and additional cranial neuropathies, including Villaret syndrome, and diminished CN V2 sensation. MRI revealed occlusive thromboses in the right transverse and sigmoid sinuses and thrombosis of the right internal carotid artery at the skull base. The patient failed to improve on culture-directed antibiotic therapy and systemic corticosteroids. Persistent inflammatory changes on imaging raised concerns for PA vs. osteomyelitis requiring prolonged antimicrobials.

Conclusions: We describe a pediatric patient with uncontrolled T1DM who developed numerous cranial neuropathies, Horner’s syndrome, and a prolonged poor clinical course due to complex PPSA and PA. Our case highlights the importance of integrated multidisciplinary care and early consideration for antibiotic coverage, antifungal use, and steroids.