BACKGROUND: Gradenigo's syndrome is a rare disease, which is characterized by 
the triad of the following conditions: suppurative otitis media, pain in the 
distribution of the first and the second division of trigeminal nerve, and 
abducens nerve palsy. The full triad may often not be present, but can develop 
if the condition is not treated correctly.
CASE PRESENTATION: We report a case of a 3-year-old girl, who presented with 
fever and left-sided acute otitis media. She developed acute mastoiditis, which 
was initially treated by intravenous antibiotics, ventilation tube insertion and 
cortical mastoidectomy. After 6 days the clinical picture was complicated by 
development of left-sided abducens palsy. MRI-scanning showed osteomyelitis 
within the petro-mastoid complex, and a hyper intense signal of the adjacent 
meninges. Microbiological investigations showed Staphylococcus aureus and 
Fusobacterium necrophorum. She was treated successfully with intravenous 
broad-spectrum antibiotic therapy with anaerobic coverage. After 8 weeks of 
follow-up there was no sign of recurrent infection or abducens palsy.
CONCLUSION: Gradenigo's syndrome is a rare, but life-threatening complication to 
middle ear infection. It is most commonly caused by aerobic microorganisms, but 
anaerobic microorganisms may also be found why anaerobic coverage should be 
considered when determining the antibiotic treatment.