Article Text

Download PDFPDF
Case report
Unusual manifestation of Koch’s disease: Gradenigo-Lannois syndrome
  1. Aswin Chandran,
  2. Prem Sagar,
  3. Rabia Monga and
  4. Shuchita Singh
  1. Otorhinolaryngology & Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
  1. Correspondence to Dr Prem Sagar; sagardrprem{at}


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’s bacilli is not rare. We report two cases of tubercular petrositis presenting as Gradenigo’s 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’s 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.

  • ear
  • nose and throat/otolaryngology
  • TB and other respiratory infections
View Full Text

Statistics from


  • Contributors AC and RM had conceptualised the work, collected the data and AC had written the manuscript, SS had made critical revision of the manuscript and PS had done the final approval of the version to be submitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.