Masked pseudomonal skull base osteomyelitis presenting with a bilateral Xth cranial nerve palsy.
Skull base osteomyelitis classically presents as a complication of severe external otitis, middle ear, mastoid or sinus infection and can lead to multiple lower cranial nerve palsies when the jugular foramen is involved as a consequence of widespread involvement of the skull base. Bilateral skull base osteomyelitis is a recognized phenomenon, but has not previously been reported secondary to pseudomonal infection in the absence of a clinically obvious focus of infection. We report the case of a 77-year-old diabetic patient who presented with dysphonia and dysphagia and had a bilateral Xth cranial nerve palsy. No focus of infection was evident on presentation. Subsequent radiological investigation confirmed the diagnosis of bilateral skull base osteomyelitis.
Rowlands
R G
RG
Department of Otolaryngology, St George's Hospital, London, UK. GRowlands1@aol.com
Lekakis
G K
GK
Hinton
A E
AE
D000368:Aged; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010019:Osteomyelitis / Q000150:complications* / Q000175:diagnosis; D011552:Pseudomonas Infections / Q000150:complications* / Q000175:diagnosis; D019291:Skull Base; D014057:Tomography, X-Ray Computed; D020421:Vagus Nerve Diseases / Q000382:microbiology*