Rare case of a 3-year-old with Candida skull base osteomyelitis: lessons to be learnt

Area of Science:

• Pediatric infectious diseases
• Otolaryngology
• Medical imaging

Background:

• Skull base osteomyelitis (SBO) is a rare, severe infection typically affecting immunocompromised adults.
• It often arises as a complication of external otitis, particularly in elderly patients.

Observation:

• A previously healthy 3-year-old girl presented with fever, vomiting, lethargy, headache, and facial nerve palsy.
• Initial CT revealed otitis media and otomastoiditis, treated with antibiotics and myringotomy.
• Deterioration led to MRI/CT confirming SBO, with *Candida albicans* identified post-mastoidectomy.

Findings:

• The case demonstrates SBO in a young, otherwise healthy child, a highly unusual presentation.
• Diagnosis was challenging, requiring advanced imaging (MRI/CT) after initial treatment failure.
• *Candida albicans* was identified as the causative agent, necessitating specific antifungal therapy.

Implications:

• This case underscores the importance of considering SBO in pediatric patients with persistent or worsening symptoms of otitis media, even without typical risk factors.
• Early and accurate diagnosis, including microbiological identification, is crucial for effective management.
• Successful treatment with antifungals and antibiotics highlights the potential for recovery in complex pediatric SBO cases.