Rare case of a 3-year-old with skull base osteomyelitis: lessons to be learnt.

BMJ Case Rep 2019 Apr 8;12(4). Epub 2019 Apr 8.

Ear, Nose and Throat Surgery, Lister Hospital, Stevenage, UK.

Skull base osteomyelitis (SBO) is a serious and rare condition most commonly seen in elderly diabetic or immunocompromised patients as a complication of otitis externa. We present the case of a previously healthy 3-year-old girl who presented to the paediatric emergency department with vomiting, fever, lethargy, headache and left-sided facial nerve palsy. The initial CT head revealed left-sided otitis media with otomastoiditis and she was managed with intravenous antibiotics and myringotomy with grommet insertion with initial improvement. Two weeks later she re-presented having deteriorated and a dedicated mastoid CT and temporal bone MRI showed SBO. She underwent urgent cortical mastoidectomy where microbiological analysis of the cultures and specimen grew She was subsequently treated with long-term antifungals and antibiotics, and eventually recovered with good effect. The diagnostic dilemma and the empirical treatment of such a rare case are discussed.

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http://dx.doi.org/10.1136/bcr-2018-228026DOI Listing
April 2019
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