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Skull base osteomyelitis

Kathryn L Kreicher, Jonathan L Hatch, Shivangi Lohia, Ted A Meyer
The microbiology of skull base osteomyelitis (SBO) is evolving. We present here the first case of SBO caused by Propionibacterium acnes leading to the development of a pseudoaneurysm of the internal carotid artery. Otolaryngologists should recognize this pathogen as a potential cause of invasive temporal bone infection to optimize prompt diagnosis and treatment. Laryngoscope, 2016.
November 15, 2016: Laryngoscope
Sharafine Stephen, Beula Subashini, Regi Thomas, Ajay Philip, Rajan Sundaresan
Malignant otitIs externa (skull base osteomyelitis) is predominantly caused by bacteria while fungal etiology is rare. We report a middle aged diabetic gentleman who succumbed to invasive skull base infection due to Apophysomyces elegans a fungus belonging to Zygomycetes which causes only skin and soft tissue infections. Mortality and invasive infections due to this genus is rarely reported, especially in the ear.
February 2016: Journal of the Association of Physicians of India
Tatsuya Ueno, Haruo Nishijima, Rie Haga, Masahiko Tomiyama
No abstract text is available yet for this article.
November 2016: Clinical Neurology and Neurosurgery
Sang Kuk Lee, Se A Lee, Sang Woo Seon, Jae Hyun Jung, Jong Dae Lee, Jae Young Choi, Bo Gyung Kim
Objectives: Malignant external otitis (MEO) is a potentially fatal infection of the external auditory canal, temporal bone, and skull base. Despite treatment with modern antibiotics, MEO can lead to skull base osteomyelitis. Until now, there have been few studies on the prognostic factors of MEO. Methods: We performed a retrospective study to identify prognostic factors of MEO, and a meta-analysis of other articles investigating MEO. On the basis of disease progression the 28 patients in our study were divided into 'controlled' and 'uncontrolled' groups, consisting of 12 and 16 patients, respectively...
September 27, 2016: Clinical and Experimental Otorhinolaryngology
G Chawdhary, S Hussain, R Corbridge
Central skull-base osteomyelitis (CSBO) is a rare life-threatening infection, usually resulting from medial spread of necrotising otitis externa. Here, we describe a case with no identifiable source of infection, causing a delay in diagnosis. An 80-year-old man with Crohn's disease treated with mesalazine presented with collapse and tonic-clonic seizure. Computed tomography and magnetic resonance imaging showed a nasopharyngeal mass that was initially thought to be a neoplasm. Awaiting formal biopsy, he represented with collapse and repeat imaging showed features of abscess formation...
January 2017: Annals of the Royal College of Surgeons of England
Eliz Kilich, Reena Dwivedi, Shelley Segal, Sandeep Jayawant, Manish Sadarangani
We describe the youngest case to date of a 2 year old child who developed central skull base osteomyelitis (SBO) initially presenting with a fever, vomiting and sore throat. An extremely rare complication of mastoiditis following otitis media in children is SBO which can present with non-specific symptoms. This report describes the first case of symptomatic ischaemic stroke secondary to SBO in an immunocompetent child. We review the literature of the management and the potential cerebrovascular complications of central SBO in children secondary to otolaryngological infection...
October 2016: International Journal of Pediatric Otorhinolaryngology
Haruka Miyabe, Atsuhiko Uno, Takahiro Nakajima, Natsue Morizane, Keisuke Enomoto, Masayuki Hirose, Toshinori Hazama, Yukinori Takenaka
Skull base osteomyelitis is classically documented as an extension of malignant otitis externa. Initial presentation commonly includes aural symptoms and cranial nerve dysfunctions. Here we present a case that emerged with multiple infarctions in the right cerebrum. A male in his 70s with diabetes mellitus and chronic renal failure presented with left hemiparesis. Imaging studies showed that blood flow in the carotid artery remained at the day of onset but was totally occluded 7 days later. However, collateral blood supply prevented severe infarction...
2016: Case Reports in Otolaryngology
Peter G Volsky, Todd A Hillman
Culture-based pathogen identification in skull base osteomyelitis, particularly for fungi, is often inaccurate. We report the case of patient with fungal skull base osteomyelitis cured by sustained antifungal therapy after 16 months of debilitating illness. Due to medical complications, a strong clinical rationale was needed to justify long-term antifungal therapy. The offending fungus was identified by experimental molecular technology (Ibis T5000 universal biosensor); invasive fungal disease was corroborated by biochemical assays...
January 2017: Laryngoscope
Sujata N Muranjan, Satish V Khadilkar, Sanjay C Wagle, Sunila T Jaggi
The aim of this study is to describe the clinical presentation of central skull base osteomyelitis and to discuss the classical imaging findings and various diagnostic and therapeutic challenges faced in the management of this condition. This is a retrospective analysis of inpatient case records, carried out in a multidisciplinary tertiary care hospital. The study subjects included five elderly diabetic patients presenting to the ENT surgeon or neurologist with headache followed by multiple cranial nerve paralysis with no temporal bone involvement in four patients and a past history of otitis externa in one patient...
June 2016: Indian Journal of Otolaryngology and Head and Neck Surgery
Anna See, Tiong Yong Tan, Eng Cern Gan
Skull base osteomyelitis typically arises as a complication of otogenic or sinonasal infections in immunocompromised patients. A much rarer entity, atypical skull base osteomyelitis is not associated with an obvious infective source. Atypical and culture-negative skull base osteomyelitis is even rarer and hampers diagnosis, as its clinical presentation is remarkably similar to skull base neoplasms. We report a case of extensive skull base osteomyelitis with orbital apex syndrome and multiple lower cranial nerve palsies which initially masqueraded as possible advanced nasopharyngeal carcinoma...
May 2016: American Journal of Otolaryngology
Päivi Jalava-Karvinen, Mikko Nyman, Maria Gardberg, Inka Harju, Ulla Hohenthal, Jarmo Oksi
We report a case of Scedosporium apiospermum mold causing ear infection, central skull base osteomyelitis and finally, occlusion of carotid artery in a 48-year-old diabetic man. The exact diagnosis was established and the severity of the disease understood several months after the onset of symptoms. Despite of appropriate antifungal therapy, and repeated surgical and otological procedures, the infection progressed to fatal cerebral infarction.
March 2016: Medical Mycology Case Reports
Jessica W Grayson, Sunny S Khichi, Do-Yeon Cho, Kristen O Riley, Bradford A Woodworth
OBJECTIVE: Inverted papilloma attached to the ventral skull base presents a surgical dilemma because surgical removal of the bony pedicle is critical to decrease risk of recurrence. The objective of this study is to evaluate the effectiveness of endoscopic management of skull base inverted papilloma. STUDY DESIGN: Case series with planned data collection. SETTING: Tertiary medical center. SUBJECTS: Patients with skull base inverted papilloma...
July 2016: Otolaryngology—Head and Neck Surgery
M R Bogomil'sky, M M Polunin, E I Zelikovich, Yu L Soldatsky, O V Burova
This publication was designed to describe a rare case of development of apicalpetrositis in a child presenting with acute otitis mediafollowing chicken pox experienced in the preceding period. We carried out the study with the use of computed tomography (CT) that demonstrated destruction of the temporal bone, bones of the base of the skull and of the first cervical vertebra. The treatment strategy chosen for the management of this condition that included antibiotic therapy and expectant observation proved justified and can be recommended as an algorithm of choice taking into consideration the difficulty of surgical approach to the apex of the petrous pyramid...
2016: Vestnik Otorinolaringologii
Laura Harrison, Jeremy Mcnally, Rogan Corbridge
A 53-year-old woman presented with right-sided otalgia radiating to the temporal region, angle of the mandible and upper neck. Otoscopy was unremarkable on examination and there were no signs of otitis externa. MRI revealed an infiltrative soft tissue mass to the right lateral aspect of the clivus. Transnasal and CT-guided biopsies were performed, however, these showed either inconclusive or benign tissue. Following multidisciplinary team assessment a diagnosis of spontaneous skull base osteomyelitis was made and treatment with intravenous antibiotics started...
February 29, 2016: BMJ Case Reports
Suck-Chul Lee, Jae-Hyung Kim, Chul-Hoon Kim, Bok-Joo Kim
Skull-base osteomyelitis is a rare disease affecting the medulla of the temporal, sphenoid, and occipital bones. In general, it occurs due to external ear canal infections caused by malignant external otitis. Skull-base osteomyelitis usually affects elderly diabetic patients. The patient, a 58-year-old man, was referred for evaluation and management of the left jaw. Clinical examination of the patient revealed pain in the left jaw and mouth-opening deflection to the left. The maximum active mouth opening was measured to about 27 mm...
December 2015: Maxillofacial Plastic and Reconstructive Surgery
Ahsan Ullah, Namal Pervez, Shammas Raza Khan, Muhammad Ishfaq, Sehrish Liaqat
Osteopetrosis is a hereditary disorder of bone characterized by sclerosis of bone and decreased marrow spaces. Due to depressed marrow function, this disorder can cause anemia, hepatosplenomegaly, recurrent infections and osteomyelitis of jaw. Excessive bone deposition in skull base leads to narrowing of foramina and cranial nerve compression. Bone marrow transplantation is the only curative treatment. Other treatments, like interferon gamma, corticosteroids, parathormone and erythropoietin are also used for management...
October 2015: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
Katarzyna Mazur-Melewska, Katarzyna Jończyk-Potoczna, Anna Mania, Paweł Kemnitz, Jarosław Szydłowski, Wojciech Służewski, Magdalena Figlerowicz
BACKGROUND: Cat-scratch disease (CSD) is a common infection in children; however, the wide spectrum of its clinical picture may lead to delayed diagnosis. An unusual presentation of CSD includes in the differential diagnosis malignant diseases, Epstein-Barr and cytomegalovirus infections, tuberculosis, and mycobacterioses. The diagnostic procedure is difficult, and it is important to consider CSD as the etiology of untypical lesion. PATIENTS AND METHOD: We present the analysis of 22 immunocompetent children treated with the clinical diagnosis of CSD in our hospital...
2015: Infectious Agents and Cancer
Yushi Ueki, Hiroshi Matsuyama, Yuka Morita, Kuniyuki Takahashi, Yutaka Yamamoto, Sugata Takahashi
Typical osteomyelitis is reportedly caused by Pseudomonous aeruginosa in elderly diabetic patients after malignant external otitis. Recently, complications have arisen due to the emergence of atypical osteomyelitis. We have experiensed 5 cases of skull base osteomyelitis at our hospital. All patients were male with a mean age of 75.2 years. Four patients had diabetes. Regarding the clinical and radiographic findings, patients 1, 2, and 3 had typical osteomyelitis after malignant external otitis, whereas patients 4 and 5 had atypical osteomyelitis without temporal bone findings...
January 2015: Nihon Jibiinkoka Gakkai Kaiho
Jingzhou He, Jonathan Chun Leuk Lam, Tarig Adlan
An increasingly reported entity, Lemierre's syndrome classically presents with a recent oropharyngeal infection, internal jugular vein thrombosis and the presence of anaerobic organisms such as Fusobacterium necrophorum. The authors report a normally fit and well 17-year-old boy who presented with severe sepsis following a 5-day history of a sore throat, myalgia and neck stiffness requiring intensive care admission. Blood cultures grew F. necrophorum and radiological investigations demonstrated left internal jugular vein, cavernous sinus and sigmoid sinus thrombus, left vertebral artery dissection and thrombus within the left internal carotid artery...
2015: BMJ Case Reports
F D Lesser, S G Derbyshire, H Lewis-Jones
BACKGROUND: Central skull base osteomyelitis is clinically difficult to distinguish from malignancy. METHOD: The computed tomography and magnetic resonance imaging scans of six patients with central skull base osteomyelitis were compared with scans from patients with a range of skull base conditions. RESULTS AND CONCLUSION: Computed tomography scans of central skull base osteomyelitis show much less bony destruction relative to the magnetic resonance imaging changes, whereas malignancy cases were associated with similar bony destruction on computed tomography and magnetic resonance imaging...
September 2015: Journal of Laryngology and Otology
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