Temporal Bone Osteomyelitis in a Child Closely Resembles Lateral Sinus Thrombosis: A Case Report

Document Type : Case Report

Authors

1 Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, India.

2 Department of Pathology, All India Institute of Medical Sciences, India.

Abstract

Introduction:
Temporal bone osteomyelitis is more commonly seen in immunocompromised patients and is very rare in non-immunocompromised individuals. Mucormycosis is a fulminating fungal infection caused by Mucor which is a saprophytic fungus commonly seen in diabetic patients. Here we report a case of temporal bone osteomyelitis in a child with a traumatic history which was causing clinical features of lateral sinus thrombosis. The patient was successfully treated and doing well post-operatively.
 
Case Report:
An 11-year-old girl was reported to the emergency dept with fever and headache for 2 weeks. She had a fever of 100–102 °F without chills and rigors which was associated with severe headache on the right side and not associated with any vomiting, nausea, or aura. The patient did not have any other significant complaints except a history of falling 2 years previously when she was 9 years of age. The patient was admitted and a complete evaluation was performed clinically and radiologically. High-resolution computed tomography (HRCT) of the temporal bone was suggestive of soft tissue density at the sigmoid sinus of the right mastoid. The patient underwent surgery for debridement, and the tissue was sent for diagnosis. This revealed mucormycosis of the temporal bone and the patient started medical management. At the present date, the patient remains under follow up.
 
Conclusion:
Fungal chronic osteomyelitis is a disease among immune-compromised patients involving the temporal bone, and is very rare. In particular mucormycosis is very rare in the temporal bone but is not expected in normal individuals. HRCT of the temporal bone is the gold standard investigation, and tissue biopsy is diagnostic. Tissue debridement and long-time medical management with anti-fungal medication is mandatory to achieve good results.

Keywords

Main Subjects

References

1. Nomiya R, Nomiya S, Paparella MM. Mucormycosis of the Temporal Bone. Otol Neurotol 2008; 29(7):1041–2.
2. Biniyam K, Bhat V, Kumar S, Bhandary B, Aroor R. Asymptomatic mucormycosis of middleear: An incidental finding during Tympanoplasty. Ind J Otol2014; 20:83–5.
3. Nirmala SVSG, Lalitha V, Sivakumar N, Kiran Kumar K, Srikanth M. Mucormycosis associated with juvenile diabetes. J Ind Soc Pedodontics Prevent Dentistr 2011; 29:87–91.
4. Alva B, Chandra Prasad K, Chandra Prasad S, Pallavi S. Temporal bone osteomyelitis and temporoparietal abscess secondary to malignant otitis externa. J Laryngol Otol 2009; 123:1288–91.
5. Blyth CC, Gomes L, Sorrel TC, da Cruz M, Sud A and Chen SCA. Skull-base osteomyelitis: fungal vs. bacterial infection, Clin Microbiol Infect 2011; 17:306–11.
6. Stodulski D, Kowalska B, Stankiewicz C. Otogenic skull base osteomyelitis caused by invasive fungal infection Case report and literature review, Eur Arch Otorhinolaryngol 2006;263:1070–6.
7. Aggarwal SK, Agarwal P. Zygomycosis of temporal bone in uncontrolled diabetes mellitus: A rare cause for skull base osteomyelitis. Muller J Med Sci Res 2015;6(1): 66-71.
8. Chan LL, Singh S, Jones D, Diaz, Jr. EM, Ginsberg LE. Imaging of Mucormycosis Skull Base Osteomyelitis, AJNR Am J Neuroradiol 2000; 21:828–31.
9. Kuruvilla G, Job A, Mathew J, Ayyappan AP, Jacob M. Septate fungal invasion in masked mastoiditis: a diagnostic dilemma. J Laryngol Otol 2006; 120:250–2.
10. Chang PC, Fischbein NJ, Holliday RA. Central Skull Base Osteomyelitis in Patients without Otitis Externa: Imaging Findings. AJNR Am J Neuroradiol 2003;24:1310–16.
Iranian Journal of Otorhinolaryngology
Volume 30, Issue 4 - Serial Number 99
July and August 2018
Pages 241-245

Files

Share

How to cite

Statistics