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Masked pseudomonal skull base osteomyelitis presenting with a bilateral Xth cranial nerve palsy

R G Rowlands1, G K Lekakis, A E Hinton

  • 1Department of Otolaryngology, St George's Hospital, London, UK. GRowlands1@aol.com

The Journal of Laryngology and Otology
|September 20, 2002
PubMed

Insights

Bilateral skull base osteomyelitis, a rare condition, was diagnosed in a diabetic patient with a pseudomonal infection. This case highlights the importance of considering this diagnosis even without an obvious infection source.

Area of Science:

  • Infectious Diseases
  • Neurology
  • Radiology

Background:

  • Skull base osteomyelitis often arises from infections of the ear, mastoid, or sinuses.
  • Involvement of the jugular foramen can cause multiple lower cranial nerve palsies.
  • Bilateral skull base osteomyelitis is uncommon, especially secondary to Pseudomonas aeruginosa without a clear infection source.

Observation:

  • A 77-year-old diabetic patient presented with dysphonia, dysphagia, and bilateral Xth cranial nerve palsy.
  • No clear source of infection was initially identified.

Findings:

  • The patient was diagnosed with bilateral skull base osteomyelitis.
  • The causative agent was identified as Pseudomonas infection.

Implications:

  • This case expands the known spectrum of skull base osteomyelitis presentation.
  • Highlights the need for thorough investigation in cases of unexplained cranial nerve palsies, even without an obvious infection focus.
  • Suggests Pseudomonas as a potential pathogen in atypical skull base osteomyelitis.

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