Idiopathic Osteomyelitis at the Base of the Skull

Yu-Che Hsiao, MD; Jin-Chin Lee, MD; Bor-Hwang Kang, MD; Yaoh-Shiang Lin, MD


South Med J. 2006;99(10):1121-1123. 

In This Article

Abstract and Introduction

Osteomyelitis of the skull base is a rare disorder, and even more so when the etiology is noninfectious. Symptoms are noisome and include headache and cranial nerve deficits. Because of the possibility of neoplasia, thorough evaluation, accurate diagnosis, and effective treatment are mandatory. In the case reported herein, a 58-year-old man with a 3-month history of symptoms is presented. Physical examination disclosed cranial nerve involvement. Nasopharyngeal biopsy and culture in combination with MRI and a gallium bone scan established the diagnosis of osteomyelitis at the base of the skull. The patient was effectively treated with antibiotics and had a complete recovery.

Most cases of osteomyelitis at the base of the skull result from the inadequate treatment of localized, chronic otitis externa.[1,2,3] Osteomyelitis of the skull base has also been described as arising from infection of the paranasal sinuses and the mandible or maxilla due to odontic caries.[3] Osteomyelitis in the cervical spine may arise following radiotherapy to the head and neck[4,5] with Pseudomonas aeruginosa as the most common organism recovered.[1,2,3] In contrast, idiopathic osteomyelitis at the base of the skull is quite rare.

The most frequent symptom occurring in such patients is headache; concomitant pain and cranial nerve involvement without an obvious source of infection make the clinical presentation more confusing and lead to a delay in diagnosis and treatment. We report a case of osteomyelitis at the base of the skull, which had no obvious contiguous infection or other predisposing factors. The diagnosis, management, and therapeutic options are discussed.


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