A case of atypical skull base osteomyelitis with septic pulmonary embolism

Skull base osteomyelitis (SBO) is difficult to diagnose when a patient presents with multiple cranial nerve palsies but no obvious infectious focus. There is no report about SBO with septic pulmonary embolism. A 51-yr-old man presented to our hospital with headache, hoarseness, dysphagia, frequent c...

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Bibliographic Details
Published in:Journal of Korean medical science 2011, 26(7), 153, pp.962-965
Main Authors: Lee, Soon Jung, Weon, Young Cheol, Cha, Hee Jeong, Kim, Sun Young, Seo, Kwang Won, Jegal, Yangjin, Ahn, Jong-Joon, Ra, Seung Won
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents - therapeutic use
Anticoagulants - therapeutic use
C-Reactive Protein - analysis
Case Report
Cranial Nerve Diseases - complications
Cranial Nerve Diseases - diagnosis
Diagnosis, Differential
Enterobacter aerogenes - isolation & purification
Enterobacteriaceae Infections - diagnosis
Enterobacteriaceae Infections - drug therapy
Humans
Lung - diagnostic imaging
Lung - pathology
Magnetic Resonance Imaging
Male
Mastoiditis - complications
Mastoiditis - diagnosis
Middle Aged
Osteomyelitis - complications
Osteomyelitis - diagnosis
Osteomyelitis - drug therapy
Pulmonary Embolism - complications
Pulmonary Embolism - diagnosis
Pulmonary Embolism - microbiology
Sinus Thrombosis, Intracranial - complications
Sinus Thrombosis, Intracranial - diagnosis
Skull Base
Sputum - microbiology
Tomography, X-Ray Computed
의학일반
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Summary:Skull base osteomyelitis (SBO) is difficult to diagnose when a patient presents with multiple cranial nerve palsies but no obvious infectious focus. There is no report about SBO with septic pulmonary embolism. A 51-yr-old man presented to our hospital with headache, hoarseness, dysphagia, frequent choking, fever, cough, and sputum production. He was diagnosed of having masked mastoiditis complicated by SBO with multiple cranial nerve palsies, sigmoid sinus thrombosis, and septic pulmonary embolism. We successfully treated him with antibiotics and anticoagulants alone, with no surgical intervention. His neurologic deficits were completely recovered. Decrease of pulmonary nodules and thrombus in the sinus was evident on the follow-up imaging one month later. In selected cases of intracranial complications of SBO and septic pulmonary embolism, secondary to mastoiditis with early response to antibiotic therapy, conservative treatment may be considered and surgical intervention may be withheld.
ISSN:1011-8934
1598-6357
DOI:10.3346/jkms.2011.26.7.962