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Tubercular skull base osteomyelitis - A case report
Akshaya Sathyamurthy Iyer1, Priya Venkatesh Patil1, Deepika Pandey1
1Department of General Medicine, Grant Medical College and Sir JJ Group of Hospitals, India.
Insights
Skull base osteomyelitis (SBO) is a rare, fatal infection. This case highlights an unusual presentation of SBO in an immunocompetent child caused by Mycobacterium Tuberculosis.
Area of Science:
- Infectious Diseases
- Osteology
- Pediatric Neurology
Background:
- Skull base osteomyelitis (SBO) is a severe infection affecting the skull base structures.
- Typically observed in immunocompromised individuals, SBO presents a diagnostic challenge.
- Early diagnosis and treatment are crucial due to its potentially fatal nature.
Observation:
- A 12-year-old immunocompetent female child presented with stroke-like symptoms.
- Incidental diagnosis of SBO was made via imaging during emergency room evaluation.
- The patient's presentation was atypical for SBO, mimicking neurological emergencies.
Findings:
- The causative agent identified was Mycobacterium Tuberculosis, an uncommon pathogen for SBO.
- This case represents a rare instance of SBO in a young, immunocompetent patient.
- The misleading initial symptoms complicated the diagnostic pathway.
Implications:
- Highlights the importance of considering unusual pathogens in SBO, even in immunocompetent patients.
- Suggests imaging protocols should be sensitive to SBO in pediatric stroke mimics.
- Underscores the need for broader differential diagnoses in pediatric infections presenting with non-specific symptoms.
Abstract:
Skull base osteomyelitis (SBO) is a complex and fatal clinical entity caused by infections in the structures surrounding the skull base. It is mainly seen in immune compromised individuals. We report one such rare case of an atypical skull base osteomyelitis in a young, immune-competent female child of 12 years of age, who presented in the ER with misleading symptoms of stroke and was diagnosed incidentally to have SBO on imaging. Adding to the uniqueness of the case is the causative organism, which was identified as Mycobacterium Tuberculosis, an unusual cause of SBO.
