title: 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.
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.
  
  
  METHODS
  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.
authors.affiliation: Infectious Diseases Unit, Hospital General Universitario de Elche, Camino de la Almazara, 11, 03203, Elche, Alicante, Spain. cristinacondediaz@gmail.com.
authors.forename: Cristina
authors.initials: C
authors.lastname: Conde-Díaz
authors.affiliation: Infectious Diseases Unit, Hospital General Universitario de Elche, Camino de la Almazara, 11, 03203, Elche, Alicante, Spain.|Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain.
authors.forename: Jara
authors.initials: J
authors.lastname: Llenas-García
authors.affiliation: Departement of Microbiology, Hospital General Universitario de Elche, Alicante, Spain.
authors.forename: Mónica
authors.initials: M
authors.lastname: Parra Grande
authors.affiliation: Infectious Diseases Unit, Hospital General Universitario de Elche, Camino de la Almazara, 11, 03203, Elche, Alicante, Spain.
authors.forename: Gertrudis
authors.initials: G
authors.lastname: Terol Esclapez
authors.affiliation: Infectious Diseases Unit, Hospital General Universitario de Elche, Camino de la Almazara, 11, 03203, Elche, Alicante, Spain.|Universidad Miguel Hernández, Alicante, Spain.
authors.forename: Mar
authors.initials: M
authors.lastname: Masiá
authors.affiliation: Infectious Diseases Unit, Hospital General Universitario de Elche, Camino de la Almazara, 11, 03203, Elche, Alicante, Spain.|Universidad Miguel Hernández, Alicante, Spain.
authors.forename: Félix
authors.initials: F
authors.lastname: Gutiérrez
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002442:Ceftazidime / Q000008:administration & dosage*; D002939:Ciprofloxacin / Q000008:administration & dosage*; D003951:Diagnostic Errors; D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D000077731:Meropenem; D010019:Osteomyelitis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D049268:Positron-Emission Tomography; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000382:microbiology; D011550:Pseudomonas aeruginosa; D019291:Skull Base / Q000000981:diagnostic imaging; D013845:Thienamycins / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents; D013845:Thienamycins; D002939:Ciprofloxacin; D002442:Ceftazidime; D000077731:Meropenem
keywords: Cranial nerve palsy; Malignant external otitis; Outpatient parenteral antibiotic therapy; Pseudomonas aeruginosa; Skull base osteomyelitis