MRSA Central Skull Base Osteomyelitis and Occipital Condylar CSF Leak

Abstract

Objective: Community acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is emerging as an important pathogen in paranasal sinus disease. However, CA-MRSA has been a rarely reported source of central skull base osteomyelitis or a subsequent occipital condylar cerebrospinal fluid leak in an otherwise immunocompetent patient. Method: Case report and current literature review. Results: We report on an unusual case of a previously healthy and immunocompetent adult who developed meningitis, central skull base osteomyelitis, and occipital condylar cerebrospinal fluid rhinorrhea from CA-MRSA sphenoid sinusitis requiring endoscopic surgical repair. Conclusion: The increasing prevalence of CA-MRSA, in conjunction with its potential for intracranial complications, challenges the otolaryngologist to remain vigilant about detecting its possible manifestations. This case clearly demonstrates the expanding spectrum of severe infections caused by CA-MRSA, which requires prompt diagnosis and appropriate medical and/or surgical management.