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Case Reports
. 2025 Mar 28;17(3):e81352.
doi: 10.7759/cureus.81352. eCollection 2025 Mar.

Clival Osteomyelitis Secondary to Isolated Sphenoid Sinusitis Caused by Nocardia veterana in an Immunocompetent Patient: A Case Report

Vita L Dingerkus  1   2 , Daman Bhatia  3 , Raymond Kim  3   4 , Vinod Khanijow  5 , Brian Sloan  6
Affiliations
Case Reports

Clival Osteomyelitis Secondary to Isolated Sphenoid Sinusitis Caused by Nocardia veterana in an Immunocompetent Patient: A Case Report

Vita L Dingerkus et al. Cureus. .

Abstract

Nocardiosis is an infectious disease caused by filamentous, saprophytic bacteria that classically affects the lungs, central nervous system, and skin as an opportunistic infection in immunocompromised patients. Although it can affect any organ system in general, osteomyelitis is not commonly seen and even more rarely involves the skull. We report the uncommon case of a clival osteomyelitis secondary to isolated sphenoid sinusitis caused by Nocardia veterana in an 85-year-old immunocompetent female who presented with right-sided facial pain, abducens nerve palsy, and eventually loss of vision.

Keywords: abducens nerve palsy; clival osteomyelitis; isolated sphenoid sinusitis; nocardia; optic neuropathy.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. CT scan findings
A: axial and coronal CT scans showing the greatest extent of right sphenoid sinusitis early after initial presentation; B: after antibiotic treatment two months later; B, C: bony erosion in the lateral sinus wall despite the finding of treated sinusitis.
Figure 2
Figure 2. MRI findings
A: MRI head and orbits revealing relatively diffuse soft tissue thickening and enhancement at right orbital apex in axial planes; B: coronal planes. The right optic nerve sheath is mildly enhancing compared to the left, with a normal appearance in signal and caliber of the optic nerve itself.
Figure 3
Figure 3. Functional endoscopical sinus surgery
Intraoperative finding during functional endoscopical sinus surgery revealing patchy demineralized bone with overlying mucosal defects. Note the close relationship of the clivus to the optic nerve (ON) as a projection of the ON shows (green lines).
Figure 4
Figure 4. Biopsy samples
A: clival bone; B: inferior orbital tissue; C: sphenopalatine artery (with surrounding stroma containing seromucinous glands), showing no inflammation or evidence of malignancy.
See this image and copyright information in PMC

References

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