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

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.