# Atypical Manifestation of Skull Base Osteomyelitis Secondary to Malignant Otitis Externa Following Radiotherapy: A Case Report

## TL;DR

A rare case of skull base osteomyelitis following radiotherapy is reported, emphasizing the need for early detection and multidisciplinary care in post-radiotherapy patients.

## Contribution

This case report highlights an atypical presentation of skull base osteomyelitis in a patient with a history of radiotherapy and diabetes.

## Key findings

- The patient presented with severe symptoms including otorrhagia and facial palsy.
- Imaging revealed extensive bone destruction and cultures identified Pseudomonas aeruginosa.
- Aggressive antibiotic treatment led to full recovery, underscoring the importance of early intervention.

## Abstract

Skull base osteomyelitis represents a rare but potentially fatal complication of malignant otitis externa (MOE), predominantly affecting elderly patients with diabetes or immunosuppression, and may also occur in individuals with a history of head and neck radiotherapy.

We report the case of a 79-year-old female with poorly controlled diabetes and a remote history of undifferentiated carcinoma of the nasopharynx (UCNT) treated with radiotherapy 17 years prior, who neglected chronic, fluctuating otalgia. She presented with massive left-sided otorrhagia complicated by hemorrhagic shock and a left peripheral facial palsy graded House-Brackmann IV. High-resolution imaging demonstrated extensive destruction of the temporal bone and skull base, and microbiological cultures identified Pseudomonas aeruginosa. Prompt, prolonged targeted antibiotics led to complete clinical recovery. This case underscores the critical importance of early recognition, meticulous longitudinal follow-up of post-radiotherapy patients, and aggressive multidisciplinary management to prevent potentially life-threatening complications. The unusual presentation of this case makes it worthy of sharing.