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Case Reports
. 2017 Feb 21;11(1):48.
doi: 10.1186/s13256-017-1221-7.

Severe Skull Base Osteomyelitis Caused by Pseudomonas Aeruginosa With Successful Outcome After Prolonged Outpatient Therapy With Continuous Infusion of Ceftazidime and Oral Ciprofloxacin: A Case Report

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Case Reports

Severe Skull Base Osteomyelitis Caused by Pseudomonas Aeruginosa With Successful Outcome After Prolonged Outpatient Therapy With Continuous Infusion of Ceftazidime and Oral Ciprofloxacin: A Case Report

Cristina Conde-Díaz et al. J Med Case Rep. .
Free PMC article

Abstract

Background: Skull base osteomyelitis is an uncommon disease that usually complicates a malignant external otitis with temporal bone involvement. It affects predominantly diabetic and immunocompromised males and has a high mortality rate. Pseudomonas aeruginosa is the most common causative organism. Currently, there is no consensus about the best therapeutic option. Here we describe a case of severe skull base osteomyelitis caused by Pseudomonas aeruginosa with progressive palsy of cranial nerves that was successfully managed with prolonged outpatient continuous infusion of ceftazidime plus oral ciprofloxacin.

Case presentation: A 69-year-old Caucasian man presented with dysphagia, headache, and weight loss. He complained of left earache and purulent otorrhea. Over the following weeks he developed progressive palsy of IX, X, VI, and XII cranial nerves and papilledema. A petrous bone computed tomography scan showed a mass in the left jugular foramen with a strong lytic component that expanded to the cavum. A biopsy was then performed and microbiological cultures grew Pseudomonas aeruginosa. After 6 weeks of parenteral antibiotic treatment, our patient was discharged and treatment was continued with a domiciliary continuous infusion of a beta-lactam through a peripherally inserted central catheter, along with an oral fluoroquinolone for 10 months. Both radiological and clinical responses were excellent.

Conclusions: Skull base osteomyelitis is a life-threating condition; clinical suspicion and correct microbiological identification are key to achieve an accurate and timely diagnosis. Due to the poor outcome of Pseudomonas aeruginosa skull base osteomyelitis, prolonged outpatient parenteral antibiotic therapy administered by continuous infusion could be a valuable option for these patients.

Keywords: Cranial nerve palsy; Malignant external otitis; Outpatient parenteral antibiotic therapy; Pseudomonas aeruginosa; Skull base osteomyelitis.

Figures

Fig. 1
Fig. 1
Petrous bone computed tomography scan shows occupation of the left middle ear and mastoid cells and erosion of the anterior wall of the middle ear (star)
Fig. 2
Fig. 2
Cranial computed tomography scan shows a mass of soft tissue (arrow) surrounding the internal jugular vein and the carotid artery at the left jugular foramen with signs of bone erosion and destruction. The lesion extends medially and causes bone destruction of the left occipital condyle and the left side edge of the clivus and erosion of the posterior edge of the oval hole. In the petrous bone it extends to the middle ear and causes erosion of the anterior wall of the tympanic cavity. The mass goes along the petrous carotid reducing its caliber and causing bone destruction of the anterior edge of the carotid canal extending to the petrous apex
Fig. 3
Fig. 3
Positron emission tomography scan showing an uptake with a standardized uptake value of 7.4 at the mass location

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References

    1. Johnson AK, Batra PS. Central skull base osteomyelitis: an emerging clinical entity. Laryngoscope. 2014;124:1083–7. doi: 10.1002/lary.24440. - DOI - PubMed
    1. Meltzer PE, Kelemen G. Pyocyaneous osteomyelitis of the temporal bone, mandible and zygoma. Laryngoscope. 1959;69:1300–16. doi: 10.1288/00005537-195910000-00006. - DOI
    1. Blyth CC, Gomes L, Sorrell TC, Da Cruz M, Sud A, Chen SCA. Skull-base osteomyelitis: fungal vs. bacterial infection. Clin Microbiol Infect. 2011;17:306–11. doi: 10.1111/j.1469-0691.2010.03231.x. - DOI - PubMed
    1. Ridder GJ, Breunig C, Kaminsky J, Pfeiffer J. Central skull base osteomyelitis: new insights and implications for diagnosis and treatment. Eur Arch Otorhinolaryngol. 2015;272:1269–76. doi: 10.1007/s00405-014-3390-y. - DOI - PubMed
    1. Adams A, Offiah C. Central skull base osteomyelitis as a complication of necrotizing otitis externa: imaging findings, complications, and challenges of diagnosis. Clin Radiol. 2012;67:7–16. doi: 10.1016/j.crad.2012.02.004. - DOI - PubMed

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