Bastianpillai Johan, Chaudhry Sidrah, Vijendren Ananth
Department of Ear, Nose and Throat Surgery, Northwick Park Hospital, Harrow, UK.
Department of Paediatrics, Lister Hospital, Stevenage, UK.
BMJ Case Rep. 2019 Apr 8;12(4):e228026. doi: 10.1136/bcr-2018-228026.
Skull base osteomyelitis (SBO) is a serious and rare condition most commonly seen in elderly diabetic or immunocompromised patients as a complication of otitis externa. We present the case of a previously healthy 3-year-old girl who presented to the paediatric emergency department with vomiting, fever, lethargy, headache and left-sided facial nerve palsy. The initial CT head revealed left-sided otitis media with otomastoiditis and she was managed with intravenous antibiotics and myringotomy with grommet insertion with initial improvement. Two weeks later she re-presented having deteriorated and a dedicated mastoid CT and temporal bone MRI showed SBO. She underwent urgent cortical mastoidectomy where microbiological analysis of the cultures and specimen grew She was subsequently treated with long-term antifungals and antibiotics, and eventually recovered with good effect. The diagnostic dilemma and the empirical treatment of such a rare case are discussed.
颅底骨髓炎（SBO）是一种严重且罕见的病症，最常见于老年糖尿病患者或免疫功能低下患者，是外耳道炎的一种并发症。我们报告一例病例，一名3岁健康女童因呕吐、发热、嗜睡、头痛和左侧面神经麻痹就诊于儿科急诊科。最初的头颅CT显示左侧中耳炎伴乳突炎，她接受了静脉抗生素治疗以及鼓膜切开置管术，病情初步好转。两周后，她病情恶化再次就诊，专门的乳突CT和颞骨MRI显示为颅底骨髓炎。她接受了紧急皮质乳突切除术，培养物和标本的微生物分析结果显示…… 随后她接受了长期抗真菌和抗生素治疗，最终康复且效果良好。本文讨论了该罕见病例的诊断困境及经验性治疗。
