Seki Masumi, Yamaoka Masayoshi, Honda Takaya, Tokoro Haruka, Matsushima Satoshi, Akiyama Masaharu
Department of Pediatrics, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
Department of Pediatrics, National Hospital Organization, Nishisaitama-chuo National Hospital, Tokorozawa, Japan.
Childs Nerv Syst. 2020 Jul;36(7):1569-1571. doi: 10.1007/s00381-019-04450-3. Epub 2019 Dec 11.
Central skull base osteomyelitis (CSBO) that has expanded to the middle cranial fossa is a rare complication of nasopharyngeal infection in children. Diagnosing CSBO is challenging in children, because specific symptoms are lacking and imaging findings can mimic skull base malignancy. We report on a 3-year-old girl who complained of pyrexia, headache, and vomiting and in whom a mass around the clivus was detected with magnetic resonance imaging. The patient received a diagnosis of CSBO based on characteristic imaging findings and the detection of a Streptococcus milleri group (SMG) in blood cultures. Clinical symptoms and abnormal imaging findings, including a mass lesion, were improved by prompt antibiotic treatment. The present patient had paranasal sinusitis with bacteremia of SMG, leading to the speculation of hematogeneous dissemination of SMG from the paranasal sinus. Awareness of CSBO, its early diagnosis, and aggressive management are required because CSBO is associated with high morbidity due to a life-threating infection involving multiple cranial nerves.
扩展至中颅窝的中央颅底骨髓炎（CSBO）是儿童鼻咽部感染的一种罕见并发症。在儿童中诊断CSBO具有挑战性，因为缺乏特异性症状且影像学表现可能类似颅底恶性肿瘤。我们报告一名3岁女孩，她主诉发热、头痛和呕吐，磁共振成像检查发现斜坡周围有一个肿块。基于特征性影像学表现及血培养中检测到米勒链球菌群（SMG），该患者被诊断为CSBO。及时的抗生素治疗使临床症状及包括肿块病变在内的异常影像学表现得到改善。本例患者患有鼻窦炎并伴有SMG菌血症，由此推测SMG是从鼻窦经血行播散的。由于CSBO因涉及多条颅神经的危及生命的感染而具有较高的发病率，因此需要认识到CSBO、对其进行早期诊断并积极治疗。
