Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-16T01:18:11.422Z Has data issue: false hasContentIssue false
  • English
  • Français

A case-based discussion on a patient with non-otogenic fungal skull base osteomyelitis: pitfalls in diagnosis

Published online by Cambridge University Press:  18 July 2013

P Asimakopoulos ,
M Supriya ,
S Kealey  and
G A Vernham
P Asimakopoulos*
Affiliation:
Department of Otolaryngology Head and Neck Surgery, University of Edinburgh Hospitals, Scotland, UK
M Supriya
Affiliation:
Department of Otolaryngology Head and Neck Surgery, University of Edinburgh Hospitals, Scotland, UK
S Kealey
Affiliation:
Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Scotland, UK
G A Vernham
Affiliation:
Department of Otolaryngology Head and Neck Surgery, University of Edinburgh Hospitals, Scotland, UK
*
Address for correspondence: Mr P Asimakopoulos, Department of Otolaryngology, Head and Neck Surgery, Aberdeen Royal Infirmary Foresterhill, Aberdeen AB25 2ZNUK E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To discuss the diagnostic pitfalls and limitations of imaging investigations in non-otogenic skull base osteomyelitis.

Case report:

This paper reports a fatal case of non-otogenic fungal skull base osteomyelitis in an immunosuppressed patient. The patient initially presented with headache and later diplopia during multiple hospital admissions. A retrospective review of the initial imaging studies of his skull base revealed subtle signs of early infection at the inferior portion of the nasopharynx. Biopsies were taken from the posterior nasopharyngeal wall. Fungal cultures isolated Aspergillus fumigatus and mucor species.

Conclusion:

The insidious onset of the clinical features and the limitations of the currently available investigations make early diagnosis of skull base osteomyelitis difficult. This case highlights that skull base osteomyelitis should be suspected in immunocompromised patients with subtle radiological abnormalities on initial imaging. There is still controversy regarding the most accurate method of investigation for early diagnosis, and quite often multiple imaging modalities are required.

Keywords

OsteomyelitisSkull BaseMucormycosisAspergillosisDiagnostic Imaging
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 127 , Issue 8 , August 2013 , pp. 817 - 821
Copyright
Copyright © JLO (1984) Limited 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Ducic, Y. Management of osteomyelitis of the anterior skull base and craniovertebral junction. Otolaryngol Head Neck Surg 2003;128:39–42CrossRefGoogle ScholarPubMed
2Ferguson, BJ. Mucormycosis of the nose and paranasal sinuses. Otolaryngol Clin North Am 2000;33:349–65CrossRefGoogle ScholarPubMed
3Lehrer, RI, Howard, DH, Sypherd, PS. Mucormycosis. Ann Intern Med 1980;93:93–108CrossRefGoogle Scholar
4Chandler, JR, Grobman, L, Quencer, R, Serafini, A. Osteomyelitis of the base of the skull. Laryngoscope 1986;96:245–51CrossRefGoogle ScholarPubMed
5Grobman, LR, Ganz, W, Casiano, R, Goldberg, S. Atypical osteomyelitis of the skull base. Laryngoscope 1989;99:671–6CrossRefGoogle ScholarPubMed
6Kountakis, SE, Kemper, JV, Chang, CY, DiMaio, DJ, Stiernberg, CM. Osteomyelitis of the base of the skull secondary to Aspergillus. Am J Otolaryngol 1997;18:19–22CrossRefGoogle ScholarPubMed
7Hoistad, DL, Duvall, AJ. Sinusitis with contiguous abscess involvement of the clivus and petrous apices. Ann Otol Rhinol Laryngol 1999;108:463–6CrossRefGoogle ScholarPubMed
8Chang, PC, Fischbein, NJ, Holliday, RA. Central skull base osteomyelitis in patients without otitis externa: imaging findings. AJNR Am J Neuroradiol 2003;24:1310–16Google ScholarPubMed
9Malone, DG, O'Boynick, PL, Ziegler, DK, Batnitzky, S, Hubble, JP, Holladay, FP. Osteomyelitis of the skull base. Neurosurgery 1992;30:426–31CrossRefGoogle ScholarPubMed
10Laccourreye, L, Halimi, P, Bonfils, P, Laccourreye, O. Atypical pseudotumoral osteomyelitis of the skull base. Otolaryngol Head Neck Surg 2007;137:524–5CrossRefGoogle ScholarPubMed
11Margalit, N. Central skull base osteomyelitis - diagnosis and treatment. In: Proceedings of the 18th Annual Meeting of the North American Skull Base Society. Los Angeles: North American Skull Base Society, 2007;14Google Scholar
12Kazim, O. Interdisciplinary approach for fungal skull base osteomyelitis. In: Proceedings of the 16th Annual Meeting of the North American Skull Base Society. Los Angeles: North American Skull Base Society, 2005;27Google Scholar
13Beahm, DD. Skull base osteomyelitis from capnocytophaga species in a 47-year-old immune competent female. In: Proceedings of the 21st Annual Meeting of the North American Skull Base Society. Los Angeles: North American Skull Base Society, 2011;38Google Scholar
14Clark, MP, Pretorius, PM, Byren, I, Milford, CA. Central or atypical skull base osteomyelitis: diagnosis and treatment. Skull Base 2009;19:247–54CrossRefGoogle ScholarPubMed
15Rowlands, RG, Lekakis, GK, Hinton, AE. Masked pseudomonal skull base osteomyelitis presenting with a bilateral Xth cranial nerve palsy. J Laryngol Otol 2002;116:556–8CrossRefGoogle ScholarPubMed
16Seabold, JE, Simonson, TM, Weber, PC, Thompson, BH, Harris, KG, Rezai, K. Cranial osteomyelitis: diagnosis and follow-up with In-111 white blood cell and Tc-99m methylene diphosphonate bone SPECT, CT, and MR imaging. Radiology 1995;196:779–88CrossRefGoogle ScholarPubMed
17Rubin, J, Curtin, HD, Yu, VL, Kamerer, DB. Malignant external otitis: utility of CT in diagnosis and follow-up. Radiology 1990;174:391–94CrossRefGoogle ScholarPubMed
18Alazraki, N, Fierer, J, Resnick, D. Chronic osteomyelitis: monitoring by 99mTc phosphate and 67Ga citrate imaging. AJR Am J Roentgenol 1985;145:767–71CrossRefGoogle ScholarPubMed
19Benecke, JR Jr.Management of osteomyelitis of the skull base. Laryngoscope 1989;99:220–3CrossRefGoogle ScholarPubMed
20Okpala, NCE, Siraj, QH. Radiological and radionuclide investigation of malignant otitis externa. J Laryngol Otol 2005;119:71–5CrossRefGoogle ScholarPubMed