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Skull base osteomyelitis by Pandoraea apista: An unusual pathogen at unusual location - A case report
Ninad Ramesh Patil1, Manjul Tripathi1, Kshitij Charaya2
1Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Background:
Pandoraea apista is predominantly recovered from the respiratory tract of patients with cystic fibrosis (CF). Authors report first case of central nervous system infection by P. apista in the form of skull base osteomyelitis.
Case Description:
A 67-year-old male presented with complaints of earache and hearing deficit for few months. The radiology was suggestive of skull base osteomyelitis and polypoidal soft tissue extending from the middle cranial fossa to the infratemporal fossa. The sample from the targeted area revealed P. apista on matrix-assisted laser desorption ionization-time-of-flight mass spectrometry. With adequate antibiotic therapy, there was clinicoradiologic improvement. P. apista is an infection exclusively seen in pulmonary infection in patients with CF. We identified its intracranial involvement in a patient for the 1st time in the literature. The serendipitous diagnosis needs evaluation on specific PCR and matrix-assisted laser desorption spectrometry. The treatment with antibiotics provides a definite cure.
Conclusion:
We report a rare opportunistic infection with central nervous system involvement which can be cured by accurate diagnosis and appropriate antibiotic treatment.
Insights
This study details the first reported case of central nervous system infection caused by Pandoraea apista, a bacterium typically found in cystic fibrosis patients. Early diagnosis and antibiotic treatment led to successful recovery, highlighting a rare opportunistic infection.
Area of Science:
- Infectious Diseases
- Neurology
- Microbiology
Background:
- Pandoraea apista is commonly associated with respiratory tract infections in cystic fibrosis (CF) patients.
- Intracranial infections by P. apista are exceptionally rare, with no prior documented cases of central nervous system (CNS) involvement.
Observation:
- A 67-year-old male presented with symptoms indicative of skull base osteomyelitis, including earache and hearing loss.
- Radiological imaging revealed soft tissue extension from the middle cranial fossa to the infratemporal fossa.
- Matrix-assisted laser desorption ionization-time-of-flight mass spectrometry identified P. apista in a sample from the affected area.
Findings:
- This case represents the first documented instance of P. apista causing central nervous system infection, specifically skull base osteomyelitis.
- The patient showed significant clinicoradiologic improvement following targeted antibiotic therapy.
- Diagnosis was aided by matrix-assisted laser desorption ionization-time-of-flight mass spectrometry and could be further refined with specific PCR.
Implications:
- This finding expands the known spectrum of P. apista infections beyond the pulmonary system.
- Accurate diagnosis and prompt antibiotic treatment are crucial for managing this rare opportunistic CNS infection.
- The case underscores the importance of considering unusual pathogens in complex infections, even in non-CF patients.
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