Skull Base Osteomyelitis as a sign of an undiscovered carcinoma

Introduction Skull base Osteomyelitis (SBO) is a life-threatening disease. Since it is primarily related to uncontrolled diabetes, other immunocompromising factors are commonly underestimated during its assessment and treatment.

Methods All cases treated for SBO in a tertiary care hospital since 2018 were retrospectively analyzed.

Results Of the eight patients identified, six presented with lateral SBO manifested as a malignant otitis externa, one patient had central SBO involving the clivus and one patient suffered from osteomyelitis of the temporal bone of uncertain etiology. Seven patients (87,5%) had diabetes as a preexisting condition. One patient had been diagnosed with a Non-Hodgkin B-cell lymphoma, prior to diagnosis and treatment of SBO. Two patients suffered from acute gastrointestinal symptoms a few weeks after the treatment for their SBO and were both diagnosed with a colon carcinoma after further examination. Based on this experience, a PET-CT-scan was initiated for the next patient presenting SBO. The PET-CT showed signs of an early-stage bronchial carcinoma. Thus, in total, four out of the eight patients (50%) had a malignant disease at the time of SBO. They all showed insufficient improvement in symptoms and findings despite weeks of application of intravenous antibiotics, surgical therapy, local treatment and well-controlled blood sugar levels.

Conclusions In atypically prolonged SBO with well-controlled diabetes and insufficient improvement through multimodal therapy, an undetected asymptomatic carcinoma as a cause of a compromised immune system should be ruled out. Additional examination with a thoracic-abdominal-CT or a PET-CT is recommended in order to detect a masked carcinoma and begin causal therapy.

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Artikel online veröffentlicht:
24. Mai 2022