Skull base osteomyelitis resulting in petrous internal carotid aneurysm

Abstract

Skull base osteomyelitis typically occurs most often as a complication of malignant otitis externa secondary to pseudomonas infection. Common risk factors are increasing age, diabetes mellitus and immunosuppression. If it happens in the absence of external otitis it is called atypical or central type. Medical management is the mainstay of treatment. Surgical management is for a diagnostic biopsy and in some for debridement. Described below is a case report of a 75 years old male patient who was diagnosed to have skull base osteomyelitis and was started on intravenous antibiotics. Following an initial improvement of symptoms, after 4 weeks he developed ear and oropharyngeal bleed. Imaging revealed a massive aneurysm of petrous internal carotid artery with multiple brain infarcts and before we could intervene the patient expired. This case emphasizes a rarity in skull base osteomyelitis and the need for early diagnosis and aggressive treatment.