Skull Base Osteomyelitis: A Diagnostic Dilemma

Abstract

Skull base osteomyelitis is a rare but potentially fatal condition. It is often characterised by a series of non-specific clinical and radiological signs, making it difficult to distinguish from a malignant lesion. We present the case of an immunocompetent elderly gentleman with multiple cranial nerve palsies and an unremarkable initial ear examination, diagnosed and treated for skull base osteomyelitis, masquerading as malignancy. This initially regressed without antibiotic therapy. This case emphasises the importance of clinicians having a high degree of diagnostic suspicion in order to initiate prompt treatment, thereby improving patient prognosis.

Keywords: diagnosis; malignancy; necrotising otitis externa; regression; skull base osteomyelitis.

Figure 1. Initial MRI brain and neck of patient – T2-weighted.

Figure 2. Repeat MRI brain and neck, three months after initial scan – T2-weighted.