scholarly journals Rare case of a 3-year-old with Candida skull base osteomyelitis: lessons to be learnt

2019 ◽  
Vol 12 (4) ◽  
pp. e228026 ◽  
Author(s):  
Johan Bastianpillai ◽  
Sidrah Chaudhry ◽  
Ananth Vijendren
Keyword(s):  
Skull Base ◽  
Rare Case ◽  
Rare Condition ◽  
Good Effect ◽  
Microbiological Analysis ◽  
Diagnostic Dilemma ◽  
Skull Base Osteomyelitis ◽  
Cortical Mastoidectomy ◽  
Ct Head ◽  
Initial Improvement

Skull base osteomyelitis (SBO) is a serious and rare condition most commonly seen in elderly diabetic or immunocompromised patients as a complication of otitis externa. We present the case of a previously healthy 3-year-old girl who presented to the paediatric emergency department with vomiting, fever, lethargy, headache and left-sided facial nerve palsy. The initial CT head revealed left-sided otitis media with otomastoiditis and she was managed with intravenous antibiotics and myringotomy with grommet insertion with initial improvement. Two weeks later she re-presented having deteriorated and a dedicated mastoid CT and temporal bone MRI showed SBO. She underwent urgent cortical mastoidectomy where microbiological analysis of the cultures and specimen grew Candida albicans. She was subsequently treated with long-term antifungals and antibiotics, and eventually recovered with good effect. The diagnostic dilemma and the empirical treatment of such a rare case are discussed.

Skull Base Osteomyelitis Resulting in Petrous Internal Carotid Aneurysm

2014 ◽  
Vol 6 (2) ◽  
pp. 34-36
Author(s):  
Suma R Radhakrishnan ◽  
Vijeyta Dahiya ◽  
Ellezhuthil Devarajan ◽  
K Ramachandran
Keyword(s):  
Skull Base ◽  
Internal Carotid ◽  
Central Type ◽  
Skull Base Osteomyelitis ◽  
Intravenous Antibiotics ◽  
Malignant Otitis Externa ◽  
Diagnostic Biopsy ◽  
Initial Improvement ◽  
Pseudomonas Infection ◽  
Common Risk Factors

ABSTRACT Skull base osteomyelitis typically occurs most often as a complication of malignant otitis externa secondary to pseudomonas infection. Common risk factors are increasing age, diabetes mellitus and immunosuppression. If it happens in the absence of external otitis it is called atypical or central type. Medical management is the mainstay of treatment. Surgical management is for a diagnostic biopsy and in some for debridement. Described below is a case report of a 75 years old male patient who was diagnosed to have skull base osteomyelitis and was started on intravenous antibiotics. Following an initial improvement of symptoms, after 4 weeks he developed ear and oropharyngeal bleed. Imaging revealed a massive aneurysm of petrous internal carotid artery with multiple brain infarcts and before we could intervene the patient expired. This case emphasizes a rarity in skull base osteomyelitis and the need for early diagnosis and aggressive treatment.

scholarly journals Skull Base Osteomyelitis Resulting in Petrous Internal Carotid Aneurysm

2014 ◽  
Vol 6 (2) ◽  
pp. 71-73 ◽  
Author(s):  
Suma R Radhakrishnan ◽  
Vijeyta Dahiya ◽  
Ellezhuthil Devarajan ◽  
K Ramachandran
Keyword(s):  
Skull Base ◽  
Internal Carotid ◽  
Central Type ◽  
Skull Base Osteomyelitis ◽  
Intravenous Antibiotics ◽  
Malignant Otitis Externa ◽  
Diagnostic Biopsy ◽  
Initial Improvement ◽  
Pseudomonas Infection ◽  
Common Risk Factors

ABSTRACT Skull base osteomyelitis typically occurs most often as a complication of malignant otitis externa secondary to pseudomonas infection. Common risk factors are increasing age, diabetes mellitus and immunosuppression. If it happens in the absence of external otitis it is called atypical or central type. Medical management is the mainstay of treatment. Surgical management is for a diagnostic biopsy and in some for debridement. Described below is a case report of a 75 years old male patient who was diagnosed to have skull base osteomyelitis and was started on intravenous antibiotics. Following an initial improvement of symptoms, after 4 weeks he developed ear and oropharyngeal bleed. Imaging revealed a massive aneurysm of petrous internal carotid artery with multiple brain infarcts and before we could intervene the patient expired. This case emphasizes a rarity in skull base osteomyelitis and the need for early diagnosis and aggressive treatment. How to cite this article Suma R, Dahiya V, Chandni R, Devarajan E, Ramachandran K. Skull Base Osteomyelitis Resulting in Petrous Internal Carotid Aneurysm. Int J Otorhinolaryngol Clin 2014;6(2):71-73.

scholarly journals Primary tuberculous skull base osteomyelitis: A rare case report

2021 ◽  
Vol 39 ◽  
pp. S93
Author(s):  
Sowjanya Perumulla ◽  
Kiran Bala ◽  
Alok Thakkar ◽  
Urvashi B. Singh
Keyword(s):  
Case Report ◽  
Skull Base ◽  
Rare Case ◽  
Skull Base Osteomyelitis ◽  
Rare Case Report

scholarly journals A diagnostic dilemma of central skull base osteomyelitis mimicking neoplasia in a diabetic patient

2013 ◽  
Vol 2013 (jan25 1) ◽  
pp. bcr2012007183-bcr2012007183 ◽  
Author(s):  
A. D. Ganhewa ◽  
J. Kuthubutheen
Keyword(s):  
Diabetic Patient ◽  
Skull Base ◽  
Diagnostic Dilemma ◽  
Skull Base Osteomyelitis

scholarly journals Diagnostic and Surgical Challenge in the Management of a Rare Tumor of Skull Base and Face

2011 ◽  
Vol 2 (3) ◽  
pp. 148-150
Author(s):  
K Senthil ◽  
A Ravi Kumar ◽  
Prasanna Kumar Saravanam
Keyword(s):  
Skull Base ◽  
Rare Case ◽  
Infratemporal Fossa ◽  
Interdisciplinary Approach ◽  
Team Approach ◽  
Rare Tumor ◽  
Diagnostic Dilemma ◽  
Formidable Challenge ◽  
Complete Surgical Excision ◽  
Lateral Skull Base

ABSTRACT Aim We report a rare case of lateral skull base hamartoma. The diagnostic dilemma, the therapeutic challenge and the importance of interdisciplinary approach to decrease the morbidity has been discussed. Method We report a rare case of a 48-year-old male with swelling over the left side of face and cheek for a duration of 12 years, who presented to us only for his cosmetic deformity and no functional impairment, after a thorough clinical examination and series of invasive and noninvasive investigations, was diagnosed to have a rare tumor hamartoma of skull base and face. A complete surgical excision without morbidity was made possible only by a multidisciplinary team approach. The investigation and surgical approach to reduce per operative morbidity has been discussed. Microscopic examination of the excised specimen with special staining techniques was conclusive for hamartoma. Patient has been on a regular follow-up for the last 2 years with no evidence of recurrence and functional compromise. Discussion The rarity of the tumor, the difficulty in diagnosis, management and prognosis of hamartoma have been discussed. Conclusion Hamartoma of the infratemporal fossa is a rare tumor and those originating in this surgically challenging site are even rarer. Further their close proximity to vital structures in head and neck poses a formidable challenge in their diagnosis and surgical management to achieve a good cosmetic and functional result.

scholarly journals Atypical skull base osteomyelitis in the intensive care unit: A case report

2017 ◽  
Vol 5 (1) ◽  
pp. 15
Author(s):  
Pradeep Hiremath ◽  
Pradeep Rangappa ◽  
Ipe Jacob ◽  
Sriram Patwari ◽  
Karthik Rao
Keyword(s):  
Skull Base ◽  
Cranial Nerve ◽  
Otitis Externa ◽  
Microbiological Analysis ◽  
Biopsy Material ◽  
Jugular Veins ◽  
Skull Base Osteomyelitis ◽  
Base Of Skull ◽  
Cranial Nerve Palsies ◽  
Magnetic Resonance Imaging Mri

Base of skull osteomyelitis is commonly seen as a complication of malignant otitis externa, involving the temporal bone. It initially presents with aural symptoms such as ear ache and discharge and cranial nerve palsies. We report an atypical presentation of skull base osteomyelitis that did not show signs of otitis externa. The patient presented with severe headache, drowsiness and signs of bulbar weakness including pooling of oropharyngeal secretions. Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) studies showed a bony erosion of the left side of base of skull involving the sphenoid bone and surrounding foramina, left sided coalescent mastoiditis and inflammation of the left parapharyngeal space. There was also inflammation of the tissues encasing the internal carotid artery and jugular veins and thrombosis of left jugular vein. These imaging findings along with cranial nerve palsies were suggestive of malignancy. However, tissue biopsy was negative for malignancy. The growth of Pseudomonas aeruginosa in the biopsy material as well as nasopharyngeal and blood cultures along with elevated Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) levels led to a diagnosis of base of skull osteomyelitis. Hence diagnosis in such cases requires that biopsy material be sent for microbiological analysis, in addition to histology.

scholarly journals Entrapment of the Basilar Artery into the Sphenoid Sinus, With CSF Fistula, without Ischaemic Stroke: A Case Report

2020 ◽  
pp. 1-3
Author(s):  
Laíse Ramos Neri ◽  
Laíse Ramos Neri ◽  
Bruno Siqueira Campos Lopes ◽  
Jorge Luís Wollstein Moritz ◽  
Lázaro Luís Faria do Amaral ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Skull Base ◽  
Basilar Artery ◽  
Sphenoid Sinus ◽  
Rare Case ◽  
Rare Condition ◽  
Skull Base Fracture ◽  
Csf Fistula ◽  
Basilar Artery Stenosis ◽  
Ct And Mri

The basilar artery herniation into the sphenoid sinus secondary to skull base fracture is a rare condition. There have been few cases described worldwide. This entity carries a potential risk of basilar artery stenosis or occlusion, resulting in ischaemia and infarction of the brainstem and cerebellum. Images study such as computed tomography (CT) and MRI plays a crucial role in diagnosing this condition. We report a rare case that shows entrapment of the basilar artery into the sphenoid sinus, after a traumatic skull base fracture, without infarction of the brainstem and cerebellum, with CSF fistula.

scholarly journals A Rare Case of Soft Tissue Erdheim Chester Disease: Diagnostic Dilemma and Management

2019 ◽  
Vol 7 (11) ◽  
pp. 1808-1811
Author(s):  
Aleksandra Pivkova-Veljanovska ◽  
Martin Ivanovski ◽  
Irina Panovska-Stavridis ◽  
Zlate Stojanoski ◽  
Sanja Trajkova ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Rare Case ◽  
Good Condition ◽  
Rare Condition ◽  
Tumour Mass ◽  
Diagnostic Dilemma ◽  
Erdheim Chester Disease ◽  
Pet Ct ◽  
Erdheim Chester ◽  
Chester Disease

BACKGROUND: Erdheim Chester disease (ECD) is a rare form of non-Langerhans histiocytosis that still presents a diagnostic and clinical dilemma. CASE PRESENTATION: We present a rare case of ECD, young 31 male with atypical localisation and soft tissue presentation and no bone involvement. He started clinical investigations due to subcutaneous tumour mass in the lumbar spine that caused severe back pain. Skin biopsy revealed ECD with Immunohistochemistry CD68+, CD10+, CD11c+, vimentin+, S100A4+. Activating BRAFV600E mutation was positive from the tumour tissue. The patient was referred to the haematology department. PET CT was performed for initial disease staging. Treatment was started with corticosteroids (methylprednisolone 0.5 mg/kg per day), and after 7 days, a significant clinical improvement was noticed in terms of pain disappearance with no need for pain killers. After two weeks, treatment with interferon Alfa (IFN-α) was started in a dose of 3 million units 3 times per week. After 4 months of interim treatment PET, CT revealed a significant reduction of the tumour mass. Therapy with IFN-α was continued, and the patient is still clinically in good condition. CONCLUSION: It can be concluded that shortening the time of diagnosis of ECD is essential in treatment outcome of this disease. Still, large studies have to confirm the best treatment of this rare condition.

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