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A case-based discussion on a patient with non-otogenic fungal skull base osteomyelitis: pitfalls in diagnosis

Published online by Cambridge University Press:  18 July 2013

P Asimakopoulos ,
M Supriya ,
S Kealey  and
G A Vernham
P Asimakopoulos*
Affiliation:
Department of Otolaryngology Head and Neck Surgery, University of Edinburgh Hospitals, Scotland, UK
M Supriya
Affiliation:
Department of Otolaryngology Head and Neck Surgery, University of Edinburgh Hospitals, Scotland, UK
S Kealey
Affiliation:
Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Scotland, UK
G A Vernham
Affiliation:
Department of Otolaryngology Head and Neck Surgery, University of Edinburgh Hospitals, Scotland, UK
*
Address for correspondence: Mr P Asimakopoulos, Department of Otolaryngology, Head and Neck Surgery, Aberdeen Royal Infirmary Foresterhill, Aberdeen AB25 2ZNUK E-mail: p_asimakopoulos@hotmail.com
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Abstract

Objective:

To discuss the diagnostic pitfalls and limitations of imaging investigations in non-otogenic skull base osteomyelitis.

Case report:

This paper reports a fatal case of non-otogenic fungal skull base osteomyelitis in an immunosuppressed patient. The patient initially presented with headache and later diplopia during multiple hospital admissions. A retrospective review of the initial imaging studies of his skull base revealed subtle signs of early infection at the inferior portion of the nasopharynx. Biopsies were taken from the posterior nasopharyngeal wall. Fungal cultures isolated Aspergillus fumigatus and mucor species.

Conclusion:

The insidious onset of the clinical features and the limitations of the currently available investigations make early diagnosis of skull base osteomyelitis difficult. This case highlights that skull base osteomyelitis should be suspected in immunocompromised patients with subtle radiological abnormalities on initial imaging. There is still controversy regarding the most accurate method of investigation for early diagnosis, and quite often multiple imaging modalities are required.

Keywords

OsteomyelitisSkull BaseMucormycosisAspergillosisDiagnostic Imaging
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 127 , Issue 8 , August 2013 , pp. 817 - 821
Copyright
Copyright © JLO (1984) Limited 2013 

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