# Skull Base Osteomyelitis Due to Staphylococcus epidermidis in the Absence of Indwelling Medical Devices Presenting With Bilateral Internal Carotid Artery Thrombosis

## TL;DR

A rare case of skull base osteomyelitis caused by Staphylococcus epidermidis without medical devices led to severe complications and death in a diabetic patient.

## Contribution

Highlights S. epidermidis as a rare cause of SBO without indwelling devices and emphasizes the need for improved awareness and treatment strategies.

## Key findings

- SBO caused by S. epidermidis led to bilateral carotid artery thrombosis and brain infarcts.
- The patient's death highlights the severity and rapid progression of SBO in diabetics.
- The case underscores the need for early diagnosis and new strategies for managing rare pathogens in low-resource settings.

## Abstract

Skull base osteomyelitis (SBO) is a severe and uncommon infection that typically affects the skull base and may arise from undiagnosed otogenic or sinonasal infection. This case describes a rare presentation of SBO, accompanied by thrombosis of the bilateral internal carotid artery with neurological deficits in a resource-limited environment, illustrating diagnostic and management dilemmas. A male patient aged 40 years with poorly controlled type 2 diabetes presented with sudden onset loss of consciousness and worsening right-sided weakness. MRI studies revealed SBO with cerebral involvement with thrombosis in major cerebral arteries and multiple brain infarcts. After receiving broad-spectrum antibiotics and supportive care shortly after admission, the patient developed septic shock and died two days after admission. The fast course of the disease in this case shows how severe SBO and its complications may be, calling for early diagnosis and intensive management of SBO, especially in diabetic patients. The fact that Staphylococcus epidermidis was established as a causative agent of disease in the absence of artificial heart valves or joints, it is becoming clear that there is a need to increase awareness of such rare pathogens, and probably new strategies for handling such infections should be developed. Additional research is required to elucidate the precise role of the pathogen and refine treatment approaches, especially for low-resource healthcare systems.