Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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December 3, 2012
Skull Base Osteomyelitis (SBO)
- SBO is a true infection of the bone—most commonly affecting patients with diabetes or in immunocompromised states like HIV/AIDS—resulting from inadequately treated chronic infection, inadequately treated otitis externa being the most common cause.
- Diagnosis of SBO should be considered in a patient with history of diabetes and ear infection with headache, multiple cranial nerve involvement, elevated ESR, and imaging features of SBO.
- Key Diagnostic Features: Both CT and MR studies are complementary toward evaluation of SBO. Findings include presence of focal erosion on CT and marrow signal abnormality on T1WI and T2WI, with associated contrast enhancement within the marrow and adjacent soft tissues, including the dural compartment.
- DDx: metastases; lymphoma
- Rx: Long-term antimicrobial therapy with aminoglycoside and a β-Lactamase antibiotic, a third generation cephalosporin, Ceftazidime, or an oral quinolone ciprofloxacin remains the mainstay of treatment.
