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

Abstract

Skull base osteomyelitis (SBO) is an invasive infection refractory to therapy, closely linked with malignant otitis externa (MOE). It is characterized by a mild clinical presentation that can delay cross-sectional imaging considered as the key to revealing it. Skull base osteomyelitis typically affects elderly diabetics and immunocompromised patients (>70 years). It most commonly has an otogenic origin due to an extension of MOE. The prognosis can be very poor without the administration of adequate and timely therapy at an early disease stage. Nowadays, Pseudomonas aeruginosa remains the most common pathogen associated with SBO. Fungi are a rare cause of MOE. This report documents a rare case of otogenic SBO caused by Candida parapsilosis in a diabetic patient, with persistent otologic symptoms as clinical onset and resistance to medical treatment. Fungal MOE has more subtle symptoms and is more aggressive than its bacterial counterpart. When MOE is resistant to antibacterial drugs, this should raise the suspicion of a fungal etiology of MOE. The current guidelines do not exhaustively describe the diagnosis, antifungal drugs of choice, and optimum duration of treatment. The description of these rare clinical cases should help with the multidisciplinary management of this disease in order to optimize the diagnosis and therapeutic protocol.

Otogenic Central Skull Base Osteomyelitis With Retropharyngeal Extension: A Case Report

“…Among the causative microorganisms, Pseudomonas aeruginosa is the most common infectious agent; nevertheless, other Gram-positive bacteria such as Staphylococcus , Streptococcus , or even fungi have been described as etiological agents [ 1 , 5 ]. Escherichia coli as species produce extraintestinal disease in immunocompromised hosts; this infectious agent can be resistant to ciprofloxacin [ 6 ].…”

Atypical Skull-Base Osteomyelitis: Comprehensive Review and Multidisciplinary Management Viewpoints

“…Some authors also report otogenic ASBO without otoscopic signs of ear infection. The absence of signs is associated with regression of necrotising external otitis, but the progression of infection at the skull base spreads to the clivus [ 6 , 16 ].…”