title: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, University of Edinburgh Hospitals, Scotland, UK. p_asimakopoulos@hotmail.com
authors.forename: P
authors.initials: P
authors.lastname: Asimakopoulos
authors.forename: M
authors.initials: M
authors.lastname: Supriya
authors.forename: S
authors.initials: S
authors.lastname: Kealey
authors.forename: G A
authors.initials: GA
authors.lastname: Vernham
mesh_terms: D000368:Aged; D001228:Aspergillosis / Q000175:diagnosis*; D001232:Aspergillus fumigatus; D057210:Delayed Diagnosis / Q000517:prevention & control; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000379:methods*; D017809:Fatal Outcome; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D009091:Mucormycosis / Q000175:diagnosis; D010019:Osteomyelitis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality; D011859:Radiography; D012189:Retrospective Studies; D019291:Skull Base / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000473:pathology