Abstract
Skull base osteomyelitis can involve the jugular foramen and its associated cranial nerves resulting in specific clinical syndromes. The Collet-Sicard syndrome describes the clinical manifestations of palsies involving cranial nerves IX, X, XI, and XII. We present a rare atypical case of skull base osteomyelitis originating from infection of the middle ear and causing the Collet-Sicard syndrome. Caused by Pseudomonas aeruginosa and Klebsiella pneumoniae, this occurred in an elderly diabetic man subsequent to retention of a cotton swab in an ear with chronic suppurative otitis media. This case report illustrates the possibility of retained cotton swabs contributing to the development of otitis media, skull base osteomyelitis, and ultimately the Collet-Sicard syndrome in the ears of immune-compromised patients with chronically perforated eardrums.
Highlights
Skull base osteomyelitis can involve the jugular foramen and its associated cranial nerves resulting in specific clinical syndromes. e Collet-Sicard syndrome describes the clinical manifestations of palsies involving cranial nerves IX, X, XI, and XII
We present a rare atypical case of skull base osteomyelitis originating from infection of the middle ear and causing the Collet-Sicard syndrome
Caused by Pseudomonas aeruginosa and Klebsiella pneumoniae, this occurred in an elderly diabetic man subsequent to retention of a cotton swab in an ear with chronic suppurative otitis media. is case report illustrates the possibility of retained cotton swabs contributing to the development of otitis media, skull base osteomyelitis, and the Collet-Sicard syndrome in the ears of immune-compromised patients with chronically perforated eardrums
Summary
Patient was given a 1-week follow-up review appointment which he defaulted. e patient returned 1 month later with a new symptom of coughing while eating for 2 weeks associated with right ear pain. e symptom was worse from swallowing solids as compared to liquids, and the patient’s intake was increasingly getting reduced. Magnetic resonance imaging (MRI) showed a large mass with central necrosis or suppuration in the right skull base, centering at the right petrous bone and the clivus (Figure 4). It involved the right jugular foramen, the right carotid canal, the right hypoglossal canal, and the nasopharynx. A clinical diagnosis of Collet-Sicard syndrome due to otitis media was made He had a peripherally inserted central catheter to facilitate intravenous antibiotics. He was treated with intravenous cefepime for 6 weeks and continued with oral levofloxacin and metronidazole thereafter E ear pain had resolved, and he was eating normally without symptoms. is was confirmed by biomedical indicators in that the C-protein level was reduced from the pretreatment level (107.40 mL) to
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