MRSA with progression from otitis media and sphenoid sinusitis to clival osteomyelitis, pachymeningitis and abducens nerve palsy in an immunocompetent 10-year-old patient.
A previously healthy 10-year-old patient with headache, otalgia, and hearing loss was diagnosed with pachymeningitis and methicillin-resistant Staphylococcus aureus otitis media and bacteremia. Despite antimicrobial therapy, intracranial extension progressed, including clival osteomyelitis, sphenoid sinusitis, cavernous sinus inflammation and cranial nerve palsies, until the sphenoid sinus was drained. This case exemplifies an aggressive MRSA intracranial infection that advanced despite antibiotic therapy.
Laurens
Matthew B
MB
Department of Pediatrics, Division of Infectious Disease and Tropical Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA. mlaurens@medicine.umaryland.edu
Becker
Randy M
RM
Johnson
Jennifer K
JK
Wolf
Jeffrey S
JS
Kotloff
Karen L
KL
D020434:Abducens Nerve Diseases / Q000209:etiology / Q000382:microbiology*; D002648:Child; D003388:Cranial Fossa, Posterior; D006801:Humans; D008297:Male; D008581:Meningitis / Q000209:etiology / Q000382:microbiology*; D016106:Methicillin Resistance; D010019:Osteomyelitis / Q000209:etiology / Q000382:microbiology*; D010033:Otitis Media / Q000150:complications / Q000382:microbiology*; D015524:Sphenoid Sinusitis / Q000209:etiology / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy; D013211:Staphylococcus aureus / Q000187:drug effects