Osteomyelitis of Skull Base: A Case Report and Review of the Literature

Abstract

Background: Malignant external otitis is a severe infection of the external auditory canal and most often affects elderly patients with diabetes mellitus. In some patients, it may progress to skull base osteomyelitis. Early diagnosis and aggressive treatment are crucial to reduce risks of dissemination.Case Report: We report a case of a 91-year-old patient with skull base osteomyelitis presenting with severe headache. There was no obvious initial sign of infection at the patient's external ear canal. Combined osteomyelitis bone scan (Tc-99m methylenediphosphonic acid bone scan and gallium scan) and magnetic resonance imaging revealed an active bone lesion in the skull base. The patient was treated with antibiotics for skull base osteomyelitis and the headache improved.Conclusions: The authors concluded that, in the elderly or immunocompromised patient, headache with active bone lesion on imaging should raise the possibility of skull based osteomyelitis, even in the absence of an obvious infective source. The primary goal should still be to exclude an underlying malignant cause.