Skull Base Fungal Osteomyelitis: A Case Report and Review of the Literature(299 views) Di Lullo AM, Russo C, Grimaldi G, Capriglione P, Cantone E, Del Vecchio W, Motta G, Iengo M, Elefante A, Cavaliere M
Ear Nose Throat J (ISSN: 0145-5613linking), 2020 Jun 25; N/D: 145561320936006-145561320936006.
Keywords: Computed Tomography, Ear Symptoms, Magnetic Resonance Imaging, Malignant Otitis Externa, Skull Base Osteomyelitis,
Affiliations: *** IBB - CNR ***
Department of Neuroscience, Reproductive and Odontostomatological Sciences, Otorhinolaryngology-Head and Neck Surgery Unit, University of Naples Federico II, Italy.
CEINGE-Advanced Biotechnology, Naples, Italy.
Department of Advance Biomedical Sciences, Neuroradiology Unit, University of Naples Federico II, Italy.
Institute of Biostructures and Bioimaging, National Research Council, Naples, Italy.
Department of Mental and Physical Health and Preventive Medicine, Otorhinolaryngology-Head and Neck Surgery Unit, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy.
References: Not available.
Skull Base Fungal Osteomyelitis: A Case Report and Review of the Literature
Skull base osteomyelitis (SBO) is an invasive infection refractory to therapy, closely linked with malignant otitis externa (MOE). It is characterized by a mild clinical presentation that can delay cross-sectional imaging considered as the key to revealing it. Skull base osteomyelitis typically affects elderly diabetics and immunocompromised patients (>
70 years). It most commonly has an otogenic origin due to an extension of MOE. The prognosis can be very poor without the administration of adequate and timely therapy at an early disease stage. Nowadays, Pseudomonas aeruginosa remains the most common pathogen associated with SBO. Fungi are a rare cause of MOE. This report documents a rare case of otogenic SBO caused by Candida parapsilosis in a diabetic patient, with persistent otologic symptoms as clinical onset and resistance to medical treatment. Fungal MOE has more subtle symptoms and is more aggressive than its bacterial counterpart. When MOE is resistant to antibacterial drugs, this should raise the suspicion of a fungal etiology of MOE. The current guidelines do not exhaustively describe the diagnosis, antifungal drugs of choice, and optimum duration of treatment. The description of these rare clinical cases should help with the multidisciplinary management of this disease in order to optimize the diagnosis and therapeutic protocol.
Skull Base Fungal Osteomyelitis: A Case Report and Review of the Literature
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