MRSA with progression from otitis media and sphenoid sinusitis to clival osteomyelitis, pachymeningitis and abducens nerve palsy in an immunocompetent 10-year-old patient

An unusual headache: Sphenoiditis in children and adolescents

“…Gram negative and anaerobic organisms are occasionally cultured [9]; Chlamydia [12], Klebsiella [14], community acquired MRSA [15] and Haemophilus influenzae [3] have also been reported. The sphenoid is the second most common sinus to be infected with fungi [16], especially with Aspergillus; this should be considered when the patient is immunocompromised [6,9].…”

Benign and malignant diseases of the clivus

“…The lesions are reported as showing strong enhancement except for giant cell tumour, which is moderately enhancing. Infection may spread from adjacent structures into the clivus 5,45 ; however, primary osteomyelitis of the clivus has also been described. 46,47 Disease arising from adjacent structures Invasive pituitary macroadenoma (Fig 9) This should be suspected when a lesion fills and expands the sella with the epicentre of the lesion being in the sella turcica.…”

Role of methicillin-resistant Staphylococcus aureus in head and neck infections

“…Vancomycin showed the highest antibiotic activity against the MRSA strains isolated. Again in the USA, Laurens et al 25 described an aggressive MRSA ear infection in a 10-year-old child. Despite antimicrobials, intracranial extension developed, as well as osteomyelitis, sphenoid sinusitis, cavernous sinus inflammation and cranial nerve palsies, until the sphenoid sinus was drained.…”