Post-traumatic Gradenigo syndrome: an uncommon complication in the antibiotic era?

Gradenigo syndrome (GS) is a rare complication of otitis media, secondary to infection spreading to the petrous apex, with potential involvement of cranial nerves V and VI. We present the unusual case of a previously healthy 5-year-old boy who developed GS after a penetrating trauma to the left ear caused by a schoolmate. The patient presented severe ear pain, purulent otorrhea, and horizontal diplopia with VI cranial nerve palsy and hemifacial hypoesthesia. CT showed petrous bone erosion, and MRI showed meningeal enhancement without abscesses. Antibiotic therapy and transtympanic ventilation tubes were placed, with complete clinical resolution. This case illustrates a rarely reported trigger of GS in pediatrics, highlighting the importance of considering this entity in complicated post-traumatic otitis, where early clinical suspicion, a multidisciplinary approach, and the timely use of imaging studies were decisive for a successful outcome.