A 66-year-old woman with hypertension presented with 2 months of progressive right earache and headache without fever, 2 weeks of mild left-sided weakness, and 1 week of intermittent hallucinations and nonsensical speech. On physical examination, the patient had a left pronator drift with the remainder of examination results being unremarkable.
The patient's erythrocyte sedimentation rate was 42 mm/h (normal, <20 mm/h), C-reactive protein level was 25 mg/L (normal, <10 mg/L; to convert to milligrams per liter, multiply by 10), and glycosylated hemoglobin A1C level was 6.8% (normal, 4.3%-6.1%; to convert to proportion of total hemoglobin, multiply by 0.01). Serological test results were unremarkable for IgG4, HIV, syphilis, tuberculosis, Toxoplasma gondii, rubella virus, cytomegalovirus, and herpes simplex virus. Cerebrospinal fluid (CSF) examination revealed no suggestive abnormalities. There was no obvious manifestation of external ear canal infection during endoscopy of the right ear. Computed tomographic scan of the temporal bone showed otitis media, mastoiditis, and local bone destruction in the right ear. The oral glucose tolerance test result confirmed the diagnosis of type 2 diabetes.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Yun Xu, MD, PhD (firstname.lastname@example.org), and Shuwei Qiu, MD, PhD (email@example.com), Department of Neurology, Drum Tower Hospital, Medical School of Nanjing University, Zhongshan Road 321#, Nanjing, Jiangsu Province, 210008, PR China.
Published Online: January 18, 2022. doi:10.1001/jamaneurol.2021.4947
Conflict of Interest Disclosures: This case report was financially supported by the National Nature Science Foundation of China (grant 81901206) and Medical Science and Technology Development Foundation of Nanjing Department of Health (grant JQX17001).
Additional Contributions: We thank the patient for granting permission to publish this information.
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