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Case Reports
. 2021 Sep 16;14(9):e243530.
doi: 10.1136/bcr-2021-243530.

Fungal central skull-base osteomyelitis: atypical presentation and management issues

Sanjeev Yadav  1 , Rajeev Kumar  2 , Rakesh Kumar  1 , Prem Sagar  1
Affiliations
Case Reports

Fungal central skull-base osteomyelitis: atypical presentation and management issues

Sanjeev Yadav et al. BMJ Case Rep. .

Abstract

Mucormycosis is a very commonly encountered disease in the sinonasal region in patients with diabetes and immunocompromised status specially in the northern part of the Indian continent. Due to its fulminant nature and involvement in the rhino-orbital-cerebral region, prognosis is poor even after extensive debridement and amphotericin-B therapy. We present a case with diagnosis of sarcoidosis being treated with systemic steroids who developed sudden-onset ptosis and left lateral rectus palsy. On radiological evaluation with MRI, a heterogenously peripherally enhancing lesion was seen in the nasopharynx suggestive of nasopharyngeal abscess. The patient was taken up for emergency surgery; a necrotic lesion with destruction of sphenoid bone, pterygoids and clivus was seen originating in the nasopharynx. The lesion on fungal staining came out to be broad aseptate hyphae suggestive of mucormycosis.

Keywords: drugs: infectious diseases; haematology (drugs and medicines).

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Gadolinium-enhanced MRI of the head and neck showed nasopharyngeal abscess with heterogenous enhancement in the left cavernous sinus and loss of T2 flow voids in the left internal carotid artery.
Figure 2
Figure 2
PET-CT scan showed proliferative necrotic lesion in the left nasopharynx (SUV max 5.2) with involvement of the left fossa of Rosenmüller, left carotid canal, pterygoid plates, basisphenoid and odontoid process.
Figure 3
Figure 3
CT angiography shows thrombosis of the left cavernous, petrous and upper cervical segments of the internal carotid artery.
Figure 4
Figure 4
Endoscopic view of necrotic tissue in the nasopharynx and pterygoid region during endoscopic debridement of disease.
See this image and copyright information in PMC

References

    1. Spagnolo P, du Bois RM. Genetics of sarcoidosis. Clin Dermatol 2007;25:242–9. 10.1016/j.clindermatol.2007.03.001 - DOI - PubMed
    1. Baughman RP, Teirstein AS, Judson MA. Clinical characteristics of patients in a case control study of sarcoidosis. Am J Respir Crit Care Med 1885;2001:15. - PubMed
    1. Yanardag H, Caner M, Papila I, et al. . Diagnostic value of peripheral lymph node biopsy in sarcoidosis: a report of 67 cases. Can Respir J 2007;14:209–11. 10.1155/2007/218947 - DOI - PMC - PubMed
    1. Zeitlin JF, Tami TA, Baughman R, et al. . Nasal and sinus manifestations of sarcoidosis. Am J Rhinol 2000;14:157–62. 10.2500/105065800782102753 - DOI - PubMed
    1. Waness A, Dawsari GA, Al Jahdali H. The rise of an opportunistic infection called "Invasive Zygomycosis". J Glob Infect Dis 2009;1:131. 10.4103/0974-777X.56256 - DOI - PMC - PubMed

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