Bruno Baršić

Klaudija Višković

Stipe Ivančić

Vladimir Krajinović

English

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Infektolo{ki glasnik 36:3-4, 135–136 (2016)Croatian Journal of Infection 36:3-4, 135–136 (2016)ISSN 1331-2820UDK 619.9 135Prepared:Stipe Ivan~i}1), MD, resident in general internal medi-cine, Memorial West Hospital, Miami, Florida, USAKlaudija Vi{kovi}2), MD, PhD, radiologistBruno Bar{i}2), MD, PhD, prof., infectious disease specialist, critical care subspecialistVladimir Krajinovi}2), MD, PhD, infectious diseasespecialist, critical care subspecialist1)Emergency Medicine Institute of Vara`din County,Vara`din, Croatia2)University Hospital for Infectious Diseases "Dr. FranMihaljevic", Zagreb, CroatiaSkull base osteomyelitis: a rare entityCentral skull base osteomyelitis is an infection local-ized to the sphenoid and temporal bones. It occurs as acomplication of malignant otitis externa and/or media.The most frequent causative pathogen is Pseudomonasaeruginosa. Risk factors include old age and diabetes.Patients usually present with symptoms of headache andcranial nerve palsies. Images in Infectious DiseasesSlike u infektivnim bolestimaFigure 1. Post contrast computed tomography (CT) scan of thebrain reveals a large, hypodense lesion in the paren-chyma of the left fronto-temporo-parietal region, spar-ing the basal ganglia. It is consistent with an acute is-chemic lesion as a result of the left internal carotidartery (ICA) sub occlusionFigure 2. Multislice computed tomography (MSCT) angiogra-phy: inflammatory infiltration of left sided skull basewith compression of the left internal carotid artery(ICA) and sub occlusive stenosis of ICA in segmentsC3 and C4 (arrow)Figure 3. Coronal post contrast T1WI of the head and neckshows extensive imbibition of inflammatory collec-tion. It was caused by destruction of the left pyramidapex and infiltrates of longus colli muscle on the leftside. Left Dorell's canal is infiltrated as well, withcompression of the abducens nerve136Images in Infectious DiseasesInfektolo{ki glasnik 36:3-4, 135–136 (2016) A 63-year old man with a previously operatedcholesteatoma was admitted to the hospital with symp-toms of vomiting and vertigo. Symptoms progressed de-spite receiving co-amoxiclav, cranial nerve palsies ap-peared and the patient was transferred to the ICU becauseof respiratory failure. The results of bloodcultures (P.aeruginosa positive) narrowed the therapy to meropenemand cefepim. During hospitalization the patient suffered amassive ischemic stroke (Fig. 1) because of compressionof the left internal carotid artery (Fig. 2). The patient dieddue to complications and spread of infection. Cranial CTis usually used as the initial diagnostic test, thoughits sensitivity in detecting disease is fairly limited withoutintial bone destruction. MRI on the other hand can different-iate between the soft tissue structures, but cannot different-iate between multiple disease processes (Fig. 3). Therapyshould be directed at P. aureginosa with a combination ofceftazidime and carbapenem for a mininum of 6 weeks. 

Slike u infektivnim bolestima: Osteomijelitis baze lubanje: rijedak entitet

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