A case of atypical skull base osteomyelitis with septic pulmonary embolism

• 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
• ISSN: 1011-8934; 1598-6357
• DOI: 10.3346/jkms.2011.26.7.962

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.