Case Reports
A Case of Skull Base Osteomyelitis in an Elderly Patient without Underlying Disease
2018 Volume 6 Issue 2 Pages 73-78
Details
2018 Volume 6 Issue 2 Pages 73-78
Skull base osteomyelitis typically results from spillover of malignant otitis externa in elderly diabetes patients following temporal bone destruction. Atypical cases do not present with such features and have been reported in recent years; most cases occur in immunocompromised patients. Here, we present a case of skull base osteomyelitis in an otherwise healthy elderly patient.
A 79-year-old man without underlying disease presented to his local clinic complaining of persistent left temporal headache and left-sided hearing loss. He was treated for about 6 months conservatively with no improvement. Imaging revealed findings suggestive of nasopharyngeal malignancy. He was then referred to our hospital for further management.
He underwent epipharyngeal biopsy twice under general anesthesia by transnasal endoscopic surgery. Histopathological examination showed only nonspecific inflammation. Pseudomonas aeruginosa was identified from a purulent discharge from the skull base during the second operation.
Integrating the clinical picture, imaging, histopathology, and bacteriology findings, we made a diagnosis of atypical skull base osteomyelitis.
He was subsequently treated with intravenous doripenem for 1 week then oral garenoxacin for 6 months. His symptoms promptly improved on treatment, with no recurrence of clinical features during an 8-month follow-up period. Also, post-recovery CT images showed new bone formation at the skull base.
It is commonly presumed that advanced age and immunosuppression are both necessary concomitant risk factors for skull base osteomyelitis, in typical and atypical cases. This patient was of advanced age, but was otherwise healthy and yet he developed atypical skull base osteomyelitis as the diagnosis could not be made during the initial examination. Accurate diagnosis requires biopsy obtained intraoperatively as well as imaging. Early treatment improves prognosis, and thus this case highlights the fact that skull base osteomyelitis could occur in healthy individuals. In this case, surgery to obtain biopsy and culture specimens was necessary for definitive diagnosis.
