Clival Osteomyelitis in an Adult Patient: A Case Report

TL;DR

A young woman with a rare skull base infection was successfully treated with surgery and antibiotics.

Contribution

This case report highlights the successful treatment of clival osteomyelitis in a young adult using endoscopic drainage and antibiotics.

Findings

MRI confirmed clival osteomyelitis and abscess in a 20-year-old patient.

Endoscopic transnasal drainage and antibiotic therapy led to uneventful recovery.

Streptococcus intermedius was identified as the causative organism.

Abstract

Clival osteomyelitis is an uncommon skull base infection that mostly affects elderly diabetics and is frequently caused by malignant otitis externa or paranasal sinus infections. It manifests as severe otalgia, fever, auditory fullness, and purulent otorrhea. Clinical history, physical examination, test data, radiographic findings, and pathogen identification all contribute to a diagnosis. Treatment consists of extended intravenous broad-spectrum antibiotics, with severe cases necessitating surgical debridement. We present a case of a 20-year-old girl with bilateral ear discharge, nasal blockage, and purulent rhinorrhea, as well as a dull neck ache increased by extension. An MRI revealed osteomyelitis in the clivus and right atlanto-occipital joint. The clival abscess was drained transnasally using endoscopic techniques. Microbiological tests revealed Streptococcus intermedius. The post-operative recovery was uneventful, with extended antibiotic therapy. Early identification and treatment are critical for preventing serious consequences, as illustrated in this case, where surgical and antibiotic care improves patient outcomes.

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