Journal of Infectious Diseases & Therapy
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Severe skull base osteomyelitis caused by Pseudomonas aeruginosa with successful outcome after prolonged outpatient therapy with continuous infusion of ceftazidime and oral ciprofloxacin: A case report
Skull base osteomyelitis is an uncommon disease that usually complicates a malignant external otitis with temporal bone involvement.
It affects predominantly diabetic and immuno compromised males and has a high mortality rate. Pseudomonas aeruginosa is the
most common causative organism. Currently, there is no consensus about the best therapeutic option. Here, we describe a case of
severe skull base osteomyelitis caused by Pseudomonas aeruginosa with progressive palsy of cranial nerves that was successfully
managed with prolonged outpatient continuous infusion of ceftazidime plus oral ciprofloxacin. A 69-year-old man presented with
dysphagia, headache and weight loss. He complained of left earache and purulent otorrhea. Over the following weeks, he developed
progressive palsy of IX, X, VI and XII cranial nerves and papilledema. A petrous-bone computed tomography showed a mass in the
left jugular foramen with a strong lytic component that expanded to the cavum. A biopsy was then performed and microbiological
cultures grew Pseudomonas aeruginosa. After six weeks of parenteral antibiotic treatment, the patient was discharged and treatment
was continued with a domiciliary continuous infusion of a beta-lactam through a peripherally inserted central catheter, along with an
oral fluoroquinolone for 10 months. Both radiological and clinical responses were excellent. Skull base osteomyelitis is a life-threating
condition; clinical suspicion and correct microbiological identification are key to achieve an accurate and timely diagnosis. Due to the
poor outcome of Pseudomonas aeruginosa skull base osteomyelitis, prolonged outpatient parenteral antibiotic therapy administered
by continuous infusion could be a valuable option for these patients.