Abstract
Here we report a patient with uncontrolled diabetes, who presented with giddiness and fall due to an episode of seizure. On evaluation with CT and MRI scans, he was found to have pan sinusitis with erosions of the skull base in the floor of sphenoid near lateral recess. PET-CT showed evidence of increased metabolism. He was operated upon by functional endoscopic sinus surgery and debridement of lesion near skull base. The histopathological examination revealed evidence of inflammation with no granulomas or fungal elements or tubercle bacilli. No organisms were grown in microbiological cultures. He started on empirical antibiotics for 3 months and showed improvement. We are reporting this case due to rarity to skull base osteomyelitis.
Highlights
Osteomyelitis is defined as an inflammatory condition of the bone that commences as an infection of the medullary cavity, rapidly involving the Haversian systems, and eventually involving the periosteum of the infected areas [1]
We report a case of osteomyelitis of floor of the sphenoid sinus extending up to the lateral recess
Skull base osteomyelitis can present with headache and a variable combination of cranial neuropathies, most often a combination of VI and lower cranial nerve (CN) neuropathies [3]
Summary
Osteomyelitis is defined as an inflammatory condition of the bone that commences as an infection of the medullary cavity, rapidly involving the Haversian systems, and eventually involving the periosteum of the infected areas [1]. Osteomyelitis of the skull base is a potentially life threatening condition if it is not diagnosed and treated early. It usually presents with chronic headache with symptoms of associated sinusitis or headache. Diagnosis is established mainly by gallium or Tc 99 scans which helps to identify the resolution of infection. CT scan would show demineralization of the bone. Morbidity and mortality can be significantly reduced by early diagnosis and treatment. The mortality rate for this condition is 53% [2]. We are reporting this case due to rarity of occurrence
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