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Skull base osteomyelitis with secondary cavernous sinus thrombosis: a rare presentation of an animate foreign body in the ear
  1. Anu Alex,
  2. Ajay Philip,
  3. Antony Abraham Paulose,
  4. Manju Deena Mammen and
  5. Anjali Lepcha
  1. Department of ENT—Otology, Neurotology & Cochlear Implant Unit, Christian Medical College and Hospital Vellore, Vellore, India
  1. Correspondence to Dr Anu Alex; anualex734{at}


A 42-year-old woman presented with fever, left ear pain, restricted mouth opening, difficulty in swallowing and inability to open her left eyelid for a period of 10 days. She was treated with antibiotics for the same at a local medical facility; however, a sudden decrease in her left eye vision prompted her to visit our tertiary centre. Her history was insignificant except for having multiple left ear syringing for an insect removal 10 days before onset of her current symptoms. On examination, she had ptosis of the left eye with chemosis, dilated pupil with only perception of light and restricted ocular mobility. Oral examination revealed trismus and bulge in the left peritonsillar region. Left ear examination revealed a large central perforation with mucopurulent discharge. CT of the neck with contrast demonstrated a collection in the left peritonsillar space with left internal carotid artery thrombosis. MRI of the brain with gadolinium revealed left cavernous sinus thrombosis with acute infarcts in the left frontal lobe. An emergency incision and drainage of the left peritonsillar abscess was performed. Culture grew broad aseptate fungal hyphae. Despite starting on antifungal therapy, she succumbed to her illness.

  • otolaryngology / ENT
  • ear
  • nose and throat/otolaryngology
  • otitis
  • raentdiology

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  • Contributors All persons who meet authorship criteria are listed as authors, and all authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing or revision of the manuscript. Furthermore, each author certifies that this material or similar material has not been and will not be submitted to or published in any other publication. AA was involved in patient care, design, planning, reporting and review of the manuscript. AP was involved in patient care, design, planning and review of the manuscript. AAP was involved in literature search, design, planning, reporting and review of the manuscript. MDM was involved in patient care, design, planning, reporting and review of the manuscript. AL was involved in patient management, design, planning, critical revisions and final review of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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