Radhakrishnan Suma, Mujeeb Hiba, Radhakrishnan Chandni
Govt. Medical College, Manjeri, Malappuram, Kerala, India.
Emergency Medicine, Govt. Medical College, Calicut, Kerala, India.
IDCases. 2020 Aug 11;22:e00930. doi: 10.1016/j.idcr.2020.e00930. eCollection 2020.
Skull base osteomyelitis is a potentially life-threatening infection, usually seen in elderly immunocompromised patients secondary to malignant otitis externa (MOE) caused by . Central or atypical skull base osteomyelitis often poses a diagnostic challenge as they present as head-ache with or without cranial nerve palsy often without any obvious source of infection. Although the incidence of fungal skull base osteomyelitis is increasing central skull base osteomyelitis due to invasive fungal sinusitis presenting with isolated hypoglossal nerve palsy has not been reported in the literature, to our knowledge. We report a case of a 59-year-old diabetic patient on regular treatment including steroid for acetylcholine receptor binding antibody positive myasthenia gravis with thymoma who presented with persistent head-ache and on evaluation, was found to have 12th cranial nerve palsy on the right side. She was diagnosed to have invasive fungal sphenoid sinusitis and central skull base osteomyelitis involving the clivus and was successfully treated with endoscopic transnasal transsphenoidal debridement followed by antifungal therapy.
颅底骨髓炎是一种潜在的危及生命的感染，通常见于因恶性外耳道炎（MOE）继发的老年免疫功能低下患者。中枢性或非典型颅底骨髓炎常常带来诊断挑战，因为其表现为伴有或不伴有颅神经麻痹的头痛，且往往没有任何明显的感染源。尽管真菌性颅底骨髓炎的发病率在上升，但据我们所知，文献中尚未报道因侵袭性真菌性鼻窦炎导致孤立性舌下神经麻痹的中枢性颅底骨髓炎。我们报告一例59岁糖尿病患者，该患者因乙酰胆碱受体结合抗体阳性重症肌无力伴胸腺瘤接受包括类固醇在内的常规治疗，出现持续性头痛，经评估发现右侧第12颅神经麻痹。她被诊断为侵袭性真菌性蝶窦炎和累及斜坡的中枢性颅底骨髓炎，并通过内镜经鼻经蝶窦清创术随后进行抗真菌治疗而成功治愈。
