Necrotizing otitis externa (NOE) represents a severe progression of otitis externa, particularly threatening in diabetic patients, with limited clinico-microbiological data for Indians. Therefore, it is of interest to evaluate the clinico-microbiological profile in 60 diabetic adults diagnosed with NOE at a tertiary center. Among participants (mean age 60.51±9.6 years; 60% male), universal findings included external auditory canal edema, otorrhea and severe nocturnal otalgia; pus cultures grew Pseudomonas spp. in 43.3% (n=26), with no growth in 13.3% (n=8), mild conductive hearing loss in 16.7% (n=10) and facial nerve palsy (with/without glossopharyngeal involvement) in 6.7% (n=4). Pseudomonas dominance and characteristic symptoms align with global patterns, but high complication rates underscore local management gaps. Thus, we report the Indian cohort profile of NOE in diabetes, informing targeted antibiotic strategies and early cranial nerve monitoring.

Neurosyphilis is a rare but reversible cause of ischemic stroke. We report a 41-year-old male with no cardiovascular risk factors initially diagnosed with Bell's palsy for left facial weakness. Four days later, he developed left-sided hemiparesis and dysarthria. Neuroimaging confirmed a right nucleocapsular ischemic stroke. Cerebrospinal fluid analysis revealed pleocytosis (39 cells/µL), elevated protein (191.9 mg/dL), and a reactive VDRL, confirming meningovascular neurosyphilis. Treatment with 14 days of intravenous Penicillin G led to complete clinical recovery after six months. This case highlights "the great imitator" during a global resurgence of syphilis. This clinical evolution highlights how isolated cranial nerve deficits can act as a deceptive precursor to a endarteritis obliterans, masking a systemic infection behind a seemingly benign presentation. In young patients with stroke and no vascular risk factors, neurosyphilis should be considered, particularly when preceded by cranial nerve deficits.