Case Report

Idiopathic Osteomyelitis at the Base of the Skull

Authors: Yu-Che Hsiao, MD, Jin-Chin Lee, MD, Bor-Hwang Kang, MD, Yaoh-Shiang Lin, MD

Abstract

Osteomyelitis of the skull base is a rare disorder, and even more so when the etiology is noninfectious. Symptoms are noisome and include headache and cranial nerve deficits. Because of the possibility of neoplasia, thorough evaluation, accurate diagnosis, and effective treatment are mandatory. In the case reported herein, a 58-year-old man with a 3-month history of symptoms is presented. Physical examination disclosed cranial nerve involvement. Nasopharyngeal biopsy and culture in combination with MRI and a gallium bone scan established the diagnosis of osteomyelitis at the base of the skull. The patient was effectively treated with antibiotics and had a complete recovery.


Key Points


* Osteomyelitis at the base of the skull is most often secondary to an infectious process.


* A noninfectious etiology for osteomyelitis at the base of the skull is rare.


* Headache, with cranial nerve deficits, should raise the suspicion of osteomyelitis at the base of the skull.


* A thorough history and physical examination, nasopharyngeal biopsy with culture, MRI, and a gallium bone scan can secure the proper diagnosis.


* Oral antibiotics are effective in resolving osteomyelitis and serve as the mainstay of treatment.

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