Cranial Nerve Palsy as a Presenting Feature of Tubercular Skull Base Osteomyelitis - A Rare Presentation

Rashmi Mishra; Naman  Suroya; Ishan Rohatgi

Rashmi Mishra Assistant Professor, Santosh Medical College, Ghaziabad, India.
Naman Suroya Junior Resident, Maulana Azad Medical College, Delhi.
Ishan Rohatgi Consultant Physician, SRS Hospital, Noida.

Keywords: Skull Base Osteomyelitis, Tuberculosis, Diplopia, Lymphadenopathy, Antitubercular Therapy

Abstract

Skull base osteomyelitis (SBO) presents diagnostic challenges due to diverse clinical manifestations mirroring other conditions. Diagnosis relies on imaging like CT and MRI, supplemented by blood cultures and
one biopsies for microbial identification. Pseudomonas aeruginosa is a common causative organism, though TB, albeit rare, has been documented. We present a case of a 22-year-old female who presented with painless left lower neck swelling along with a persistent headache, weight loss, and decreased appetite. Examination revealed a discrete, firm, non-tender, mobile cervical lymphadenopathy. Initial investigations were unremarkable except for an elevated erythrocyte sedimentation rate, prompting further evaluation. Aspiration cytology revealed a suppurative lesion, with no response to treatment with amoxicillin and clavulanic acid. She noticed the development of double vision for which magnetic resonance imaging was done which revealed altered signal intensity in the skull base suggestive of osteomyelitis, with associated pachymeningitis. Cerebrospinal fluid analysis showed lymphocytic pleocytosis. Against the backdrop of the isolation of acid-
fast bacilli on lymph node biopsy, a diagnosis of tubercular SBO with cervical lymphadenopathy was made. Initiated antitubercular therapy resulted in gradual resolution of symptoms over a 6-week period, with continued treatment for 12 months leading to complete recovery. This case underscores the need for comprehensive assessment to effectively address unusual clinical presentations.

How to cite this article:
Mishra R, Suroya N, Rohatgi I. Cranial Nerve Palsy
as a Presenting Feature of Tubercular Skull Base
Osteomyelitis - A Rare Presentation. J Adv Res
Med 2023; 10(1): 16-20.

DOI: https://doi.org/10.24321/2349.7181.202305

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