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Skull Base Osteomyelitis: A Case Report and Literature Review
Nathaniel Dusini1,2, Gregory M Buchek3,4
1Internal Medicine, Wright-Patterson Medical Center, Wright-Patterson Air Force Base, USA.
Abstract:
Skull base osteomyelitis (SBO) is a rare but potentially life-threatening serious infection. It is most often caused by Pseudomonas aeruginosa and typically affects elderly people with diabetes or weakened immune systems. We present an 80-year-old man with diabetes who was diagnosed with SBO with left facial nerve involvement after initial misdiagnosis and inadequate response to treatment for otitis externa and Bell's palsy. Imaging and transmastoid biopsy confirmed the diagnosis. Although prolonged antibiotic therapy suppressed the infection, the left facial nerve palsy remained unresolved. This case highlights the diagnostic challenges, the need for early imaging and biopsy, and the importance of tailored treatment and long-term follow-up to prevent irreversible complications.
Insights
Skull base osteomyelitis (SBO) is a rare infection often affecting elderly diabetics. Early imaging and biopsy are crucial for diagnosis and tailored treatment to prevent complications like facial nerve palsy.
Area of Science:
- Infectious Diseases
- Neurology
- Otolaryngology
Background:
- Skull base osteomyelitis (SBO) is a rare, severe infection, often caused by Pseudomonas aeruginosa.
- It predominantly affects elderly individuals with diabetes or compromised immune systems.
Observation:
- An 80-year-old male with diabetes presented with SBO and left facial nerve involvement.
- Initial misdiagnosis as otitis externa and Bell's palsy led to inadequate treatment.
- Diagnosis was confirmed via imaging and transmastoid biopsy.
Findings:
- Prolonged antibiotic therapy managed the infection but did not resolve the facial nerve palsy.
- This case underscores diagnostic challenges in SBO, particularly with facial nerve involvement.
Implications:
- Highlights the critical need for prompt imaging and biopsy in suspected SBO cases.
- Emphasizes the importance of individualized treatment plans and long-term monitoring for SBO patients.
- Underscores the potential for irreversible complications, such as persistent facial nerve palsy, if not managed effectively.
