September 2023
An 83-year-old man with dysphagia, odynophagia, nausea, vomiting, and occipital headaches for 3 weeks and a 25-pound weight loss in 6 months
Skull Base Osteomyelitis
- Background:
- Skull base osteomyelitis is a relatively rare, potentially life-threatening infection typically caused by otogenic or nasal sinus infection in immunocompromised or elderly with diabetes.
- However, skull base osteomyelitis may present in immunocompetent individuals without diabetes with a more non-specific, indolent course.
- Clinical Presentation:
- Patients typically present with symptoms related to otitis externa or temporal bone infection, such as headache, facial pain or otalgia.
- Key Diagnostic Features:
- CT images show erosion of the cortex involving the skull base such as the sphenoid, petrous apices, clivus and jugular foramen.
- MRI images show enhancing soft tissue mass on T1 and soft tissue edema which appear T1 hypointense and T2 hyperintense.
- In both CT and MRI, effacement of fat planes, vascular complications and involvement of lateral structures may occur.
- Differential Diagnoses:
- Nasopharyngeal carcinoma: Presence of an abscess favors skull base osteomyelitis.
- Inflammatory pseudotumor: Biopsy will show chronic inflammatory cells including both B cells and T cells.
- Metastasis: Medical history of a known primary malignancy supports this diagnosis.
- Treatment:
- Long-term broad-spectrum IV antibiotics which may also require surgical debridement depending on severity
