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A pediatric case of central skull base osteomyelitis caused by Streptococcus milleri group infection and mimicking
Masumi Seki1, Masayoshi Yamaoka1, Takaya Honda1
1Department of Pediatrics, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
Abstract:
Central skull base osteomyelitis (CSBO) that has expanded to the middle cranial fossa is a rare complication of nasopharyngeal infection in children. Diagnosing CSBO is challenging in children, because specific symptoms are lacking and imaging findings can mimic skull base malignancy. We report on a 3-year-old girl who complained of pyrexia, headache, and vomiting and in whom a mass around the clivus was detected with magnetic resonance imaging. The patient received a diagnosis of CSBO based on characteristic imaging findings and the detection of a Streptococcus milleri group (SMG) in blood cultures. Clinical symptoms and abnormal imaging findings, including a mass lesion, were improved by prompt antibiotic treatment. The present patient had paranasal sinusitis with bacteremia of SMG, leading to the speculation of hematogeneous dissemination of SMG from the paranasal sinus. Awareness of CSBO, its early diagnosis, and aggressive management are required because CSBO is associated with high morbidity due to a life-threating infection involving multiple cranial nerves.
Insights
Central skull base osteomyelitis (CSBO) is a rare complication in children, often mimicking malignancy. Prompt diagnosis and antibiotic treatment of Streptococcus milleri group infections are crucial for recovery and preventing severe complications.
Area of Science:
- Pediatric infectious diseases
- Neuroradiology
- Skull base pathology
Background:
- Central skull base osteomyelitis (CSBO) is a rare but serious complication of nasopharyngeal infections in children.
- Diagnosis can be challenging due to nonspecific symptoms and imaging that may resemble skull base malignancy.
Observation:
- A 3-year-old girl presented with pyrexia, headache, and vomiting.
- Magnetic resonance imaging revealed a clival mass, leading to a CSBO diagnosis.
- Streptococcus milleri group (SMG) was identified in blood cultures.
Findings:
- Characteristic imaging findings and positive blood cultures confirmed CSBO.
- Prompt antibiotic therapy led to improvement in clinical symptoms and imaging abnormalities.
- The case suggests hematogenous dissemination of SMG from concurrent paranasal sinusitis.
Implications:
- Highlights the importance of considering CSBO in pediatric patients with relevant symptoms.
- Emphasizes the need for early diagnosis and aggressive management of CSBO.
- Underscores the potential for severe morbidity associated with cranial nerve involvement in life-threatening infections.
