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Ann Saudi MedAnn Saudi MedAnnals of Saudi Medicine0256-49470975-4466King Faisal Specialist Hospital and Research Centre 1676145810.5144/0256-4947.2006.155asm-2-155What’s Your Diagnosis?A 7-year old boy with recurrent attacks of Streptococcus pneumoniae meningitis Al Shamsan Layla *Weir Norman †Palkar Vijay ‡Hatlani MaherAl *Al Banyan Esam *Frayha Husn 
* Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
† Department of Otolaryngology, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
‡ Department of Radiology, King Abdulaziz Medical City, Riyadh, Saudi ArabiaCorrespondence and Reprint Requests: Layla Al Shamsan, MD, Department of Pediatrics, King Fahad National Guard Hospital, Riyadh, Tel: +966-1-252 0088 ext. 1630, Fax: +966-1-252 0088 ext. 1641, shamsanla@ngha.med.saMar-Apr 2006 26 2 155 155 Copyright © 2006, Annals of Saudi Medicine2006This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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A 7-year-old boy who had recurrent attacks of Streptococcus pneumoniae meningitis was admitted. The mother reported a history of mild head trauma two months prior to the first episode. On further enquiry it was discovered that the patient had a history of right ear discharge during early childhood with no recollection by the family of the exact time and duration. There was no history of recurrent sinopulmonary infections or hearing difficulties. Workup included auditory testing, which showed right-sided profound sensorineural hearing loss, a high-resolution temporal bone CT scan (Figure 1a), and MRI (Figure 2b).

What are the abnormal findings on the CT scan and MRI of the temporal bone?

Name the associated condition?

Why are patients with this condition at risk of meningitis?

Answer on page 163

Figure 1a CT scan of the right petrous bone

Figure 2a MRI of the temporal bones