Osteomyelitis of the skull base--an unusual manifestation

A 74-year-old male was seen and evaluated for a pale right tympanic membrane accompanied by posterior neck pain and a mass in the right nasopharynx. Repeated biopsies failed to confirm the expected diagnosis, only yielding lymphatic tissue with chronic inflammation and scarring. The patient was admitted when he suddenly developed ipsilateral cranial palsies, and the radiologic evaluation suggested a vascular tumor. His general condition and neurologic status rapidly declined, and the patient expired shortly after admission. Postmortem examination revealed osteomyelitis of the skull base without evidence of vascular lesion, or middle ear or external canal pathology. The significance of the radiologic evaluation and of this diagnosis are discussed.