A pediatric case of central skull base osteomyelitis caused by Streptococcus milleri group infection and mimicking malignancy

Dysphagia and Tongue Deviation: An Unexpected Cause

“…S. intermedius was involved in 4 cases, and of these, 2 had documented sinusitis and none had otitis or mastoiditis. 1,5 In cases without a clear source, distant seeding from S. intermedius bacteremia remains a possibility, as suspected in our case. Of note, although our patient's antistreptolysin O titer was elevated, a single measurement can have a considerable falsepositivity rate, and, therefore, we did not consider it a significant finding.…”

“…4,6 Imaging plays a vital role in the diagnosis of CSBO. 3,6 MRI has the highest sensitivity and specificity due to higher soft tissue discrimination and better visualization of bone marrow abnormalities compared with CT. 2,3,5-7 MRI findings of osteomyelitis include bone marrow T2 hyperintensity, contrast enhancement and adjacent soft tissue abnormalities, 1,3,[6][7][8] which were all present in our patient. MRI and single-photon emission computerized tomography/computed tomography are useful for monitoring treatment response.…”

“…In conclusion, CSBO is a rare but serious infection that is potentially life-threatening 1,2,6,9 and can be easily misdiagnosed due to its subtle and nonspecific clinical presentation. Early diagnosis and prompt treatment are crucial due to the high morbidity related to the involvement of multiple cranial nerves and the high mortality rate.…”

“…Atypical skull base osteomyelitis, also known as central skull base osteomyelitis (CSBO), affects the sphenoid and occipital bones, mainly the clivus. [1][2][3][4][5][6][7] It is a less frequent condition that usually arises from a paranasal infection unrelated to otologic pathology, 2,5,7 such as sphenoidal or ethmoidal sinusitis, or from direct spread of an infectious process affecting the mastoid, retropharynx or oral cavity. 2,4,5 It can also be hematogenous in origin.…”

“…1,[8][9][10][11][12] The clinical presentation of CSBO can be subtle and of nonspecific nature. [4][5][6][7] Pediatric patients can present with headache, sometimes as the only symptom, [1][2][3][4]6,7 and fever, 2,[4][5][6] though this may be absent in immunocompromised patients. 6 Other symptoms may include neck/facial pain, neck stiffness, torticollis and sinus tenderness.…”