Community‐acquired methicillin‐resistant Staphylococcus aureus skull base osteomyelitis with occipital condylar cerebrospinal fluid leak in an immunocompetent patient

Abstract

Community acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is emerging as an important pathogen in paranasal sinus disease. However, sinonasal CA-MRSA has not been reported as a source of central skull base osteomyelitis. We report an unusual case of a previously healthy and immunocompetent adult who developed meningitis, central skull base osteomyelitis, and occipital condylar cerebrospinal fluid rhinorrhea from CA-MRSA sphenoid sinusitis requiring endoscopic surgical repair. This case clearly demonstrates the expanding spectrum of severe infections caused by CA-MRSA, which requires prompt diagnosis, a high level of suspicion, and appropriate medical and/or surgical management.

Central skull base osteomyelitis

“…Given its proximity to the EAC on exiting the skull base, CN VII is most commonly affected, followed by CNs IX, X, XI, and XII . Pseudomonas aeruginosa is the single causative organism in the majority of cases, though less commonly fungal or mixed bacterial infections have been documented . Given the well‐documented disease progression from otitis to osteomyelitis, the term SBO has come to be used interchangeably with necrotizing or malignant otitis externa (MOE).…”

Endoscopic Cerebrospinal Fluid Leak Closure in an Infected Field

“…Previous reports in the literature are limited. Tomovic et al 16 described a patient with MRSA sphenoid sinusitis that progressed to meningitis and central skull base osteomyelitis. The patient developed CSF rhinorrhea 5 days after endoscopic sinus surgery and underwent successful urgent endoscopic repair with an abdominal fat graft and pedicled nasoseptal flap.…”