Skull Base Osteomyelitis Complicating COVID-19: A Novel Secondary Infection?

Data from the onset of the Coronavirus Disease 2019 (COVID-19) pandemic has revealed a broad spectrum of clinical conditions and comorbidities. Secondary infections, such as sinonasal mucormycosis, have become more frequent due to COVID-19-related immunosuppression and its subsequent treatments. Skull base osteomyelitis is another potentially fatal infection that is prevalent among immunocompromised individuals. Angiotensin-Converting Enzyme 2 (ACE2) receptors in the external auditory canal may also be implicated in cases of external otitis linked to COVID-19.

This report discusses two cases of treatment-resistant external otitis and skull base osteomyelitis in two elderly, immunosuppressed patients (with diabetes mellitus and chronic renal failure) who had previously been treated for COVID-19. In both cases, neither topical nor intravenous antibiotic treatments were effective, leading to referrals for hyperbaric oxygen therapy.

For patients exhibiting persistent ear discharge and a history of COVID-19, it is imperative to avoid underestimating a potential diagnosis of skull base osteomyelitis and to pursue early imaging.