Community-acquired methicillin-resistant Staphylococcus aureus skull base osteomyelitis with occipital condylar cerebrospinal fluid leak in an immunocompetent patient

Authors

  • Senja Tomovic MD,

    1. Department of Otolaryngology–Head and Neck Surgery, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey, U.S.A.
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  • Mark E. Friedel MD, MPH,

    1. Department of Otolaryngology–Head and Neck Surgery, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey, U.S.A.
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  • James K. Liu MD,

    1. Department of Neurological SurgeryUniversity of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey, U.S.A.
    2. Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey, U.S.A.
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  • Jean Anderson Eloy MD, FACS

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey, U.S.A.
    2. Department of Neurological SurgeryUniversity of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey, U.S.A.
    3. Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey, U.S.A.
    • Assistant Professor and Vice Chairman, Director of Rhinology and Sinus Surgery, Department of Otolaryngology–Head and Neck Surgery, Neurological Institute of New Jersey, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, 90 Bergen St., Suite 8100, Newark, NJ 07103
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  • Presented at the Annual Meeting of the American Academy of Otolaryngology–Head and Neck Surgery Foundation, San Francisco, California, U.S.A., September 10–14, 2011.

Abstract

Community acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is emerging as an important pathogen in paranasal sinus disease. However, sinonasal CA-MRSA has not been reported as a source of central skull base osteomyelitis. We report an unusual case of a previously healthy and immunocompetent adult who developed meningitis, central skull base osteomyelitis, and occipital condylar cerebrospinal fluid rhinorrhea from CA-MRSA sphenoid sinusitis requiring endoscopic surgical repair. This case clearly demonstrates the expanding spectrum of severe infections caused by CA-MRSA, which requires prompt diagnosis, a high level of suspicion, and appropriate medical and/or surgical management.

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