Skull base osteomyelitis: clinical and radiologic analysis of a rare and multifaceted pathological entity

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

“…Main clinical features of otogenic SBO are extremely painful otitis externa and facial palsy such as in our case along with headaches and cranial nerve neuropathies. 8,11 Considering the clinical complexity of SBO, multidisciplinary management is necessary, involving an otolaryngologist, neurosurgeon, radiologist, and infectiologist. 8 Pseudomonas aeruginosa is a Gram-negative aerobe that colonizes the external auditory canal with a high moisture content, especially in immunocompromised subjects due to the presence of a mucoid layer (hindering phagocytosis) and lytic enzymes (promoting necrotizing vasculitis and arteritis).…”

“…Malignant otitis externa is an invasive infection of the external ear and temporal bone that can typically affect elderly diabetic patients such as in our case. [5][6][7][8] The term ''malignant'' highlights the aggressive behavior of this pathology spreading outside the external auditory canal. 6 In fact, the infection begins as external otitis with ear pain, otorrhea, and aural fullness up to involving the middle ear and the skull base with high mortality and morbidity due to the proximity of these structures.…”

“…5,6 Skull base osteomyelitis is an inflammatory process of bony structures of the cranial base. 8 In the literature, Mortazavi et al 9 and Das et al 10 proposed an SBO classification based on 2 general categories: ''sinorhino-otogenic'' or ''otogenic'' and ''non-sinorhino-otogenic'' or ''nonotogenic'' groups due to different clinical features. 9,10 As in our case, otogenic SBO represents one of the higher risk complications due to the spread of the external ear canal infection to the temporal bone and subsequent skull base involvement through the fissures of Santorini.…”

“…8,11 Considering the clinical complexity of SBO, multidisciplinary management is necessary, involving an otolaryngologist, neurosurgeon, radiologist, and infectiologist. 8 Pseudomonas aeruginosa is a Gram-negative aerobe that colonizes the external auditory canal with a high moisture content, especially in immunocompromised subjects due to the presence of a mucoid layer (hindering phagocytosis) and lytic enzymes (promoting necrotizing vasculitis and arteritis). Pseudomonas aeruginosa is considered the etiological agent in 50% to 90% of MOE patients; although different microorganisms can also be isolated, especially in nondiabetic patients (5% to 20% of cases) such as Staphylococci (S. aureus, especially Methicillin-resistant S. Aureus -MRSA , Staphylococcus epidermidis), Streptococci, and Gram-negative bacteria (Klebsiella spp, Proteus mirabilis, or Raoultella ornithinolytica).…”

Prolonged headache caused by central skull base osteomyelitis with epidural abscess in type 1 diabetes mellitus

“…Idiopathic CSBO is difficult to diagnose in clinical and radiological practice 1–3 . This case characteristically presented with an epidural abscess.…”