Central or Atypical Skull Base Osteomyelitis Consecutive to Sinusitis Infections

Introduction: Skull base osteomyelitis typically arises as a complication of ear infection in older diabetic patients, involves the temporal bone, and has Pseudomonas aeruginosa as the usual pathogen. Atypical skull base osteomyelitis arising from the sphenoid or occipital bones without associated external otitis occurs much less frequently. The purpose of this study was to review the clinical features and determine efficacy of treatment for nonotologic osteomyelitis of the skull base. Methods: We retrospectively reviewed two cases of central or atypical skull base osteomyelitis. Results: The two patients presented with asthenia, headache, and fever. No patient presented with neurologic deficits. Contrary to malignant otitis externa, our cases were not preceded by immediate external infections and had normal external ear examinations. One patient had an underlying immunocompromising condition. Imaging demonstrated bone destruction, subsequent microbiological analysis diagnosed infection, and a biopsy proved diagnosis of osteomyelitis, a prolonged antibiotic treatment was instored. The two patients were cured with no recurrence of skull base infection over a 12-month follow-up period. Conclusion: Central skull base osteomyelitisis is a rare disease whose treatment requires an early bone biopsy and appropriate treatment to prevent or limit other complications such as intracranial extension, empyema or death.