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Case of the Week

Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada

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December 3, 2012
A 60-year-old man with uncontrolled diabetes presented with left-sided earache and ear discharge, headache, facial deviation, and hearing loss since nine months. Progressively he developed dysphagia, hoarseness of voice and drooping of left shoulder, and upon examination he had bilateral VI, IX, X, and left facial and XI cranial nerve palsy with bilateral conductive hearing loss.

Bloodwork:
Hemoglobin: 13.3 gm/100 ml
Total count: 13000 cells/c m P 82E 1 L17
Erythrocyte sedimentation rate: 110
Random blood sugar: 180mg/dl with glycosilated hemoglobin of 8.9%
CSF: 5 cells/mm3, all lymphocytes
Protein: 90 mg%
Sugar: 68 mg%
Random glucose: 95 mg%
CSF TB PCR: panfungal antigen and malignant cytology → negative

Case submitted by Sujit Jagtap; M.D. Nair; Bejoy Thomas; Sree Chitra Triunal Institue of Medical Sciences and Technology, Trivandrum, Kerala, India.

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