case_images: PMC11100390_01
case_images: (a) Contrast-enhanced temporal bone computed tomography (CT). Bone destruction in the cortical bone at the apex of the temporal bone and clivus can be seen. (circle) (b) A heterogeneously enhancing soft-tissue lesion involving the left nasopharynx can be observed in contrast-enhanced CT (circle).
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case_images: CT scan with contrast showed bone destruction of the cortical bone at the apex of the temporal bone and clivus (Figure 1).
case_images: (a) Contrast-enhanced magnetic resonance imaging (MRI). Contrast effect observed on the left side of the nasopharynx in enhanced T1 weighted MR image. (circle) (b) Slight hyperintensity is shown on the nasopharyngeal soft tissue in diffusion-Weighted Imaging (DWI). (c) Relative low Apparent diffusion coefficient (ADC) values can be observed on the nasopharyngeal soft tissue in ADC. (d) No neoplastic lesions can be observed on the nasopharyngeal soft tissue in FLAIR.
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case_images: Contrast-enhanced magnetic resonance imaging (MRI) revealed a contrast effect on the left side of the nasopharynx (Figure 2), and gallium scintigraphy showed significant accumulation of the radiotracer in the left skull base (Figure 3). Cefepime (CFPM) treatment was initiated for a diagnosis of malignant SBO.
case_images: Ga scintigraphy Gallium scintigraphy was performed every 6-8 weeks. Gallium scintigraphy showed a reduction in the gradual accumulation (arrows), which almost disappeared after 1 year of cefepime administration.
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case_images: Contrast-enhanced magnetic resonance imaging (MRI) revealed a contrast effect on the left side of the nasopharynx (Figure 2), and gallium scintigraphy showed significant accumulation of the radiotracer in the left skull base (Figure 3). Cefepime (CFPM) treatment was initiated for a diagnosis of malignant SBO.
case_images: Otoscopic findings. Bone necrosis was observed in the external auditory canal. Six weeks after skull base osteomyelitis treatment, the patient's condition improved.
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case_images: The patient was closely monitored with gallium scintigraphy every 6-8 weeks, in addition to the monitoring of symptoms, otoscopic findings (Figure 4), and laboratory tests (Figure 5).
case_images: Antibiotic therapy and inflammation (0 weeks (wk): at the time of skull base osteomyelitis (SBO) diagnosis). There was a mild inflammatory response at the time of SBO diagnosis, which promptly improved. CFPM: cefepime, LVFX: levofloxacin.
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case_images: The patient was closely monitored with gallium scintigraphy every 6-8 weeks, in addition to the monitoring of symptoms, otoscopic findings (Figure 4), and laboratory tests (Figure 5).