Gallium Scintigraphy-Guided Discontinuation of Antibiotics in Skull Base Osteomyelitis: A Case Report.
- 1Department of Otolaryngology Head and Neck surgery, Kumamoto University , Kumamoto, Kumamoto Prefecture 860-8555, Japan.
Abstract
Skull base osteomyelitis (SBO) is a rare and potentially life-threatening infection often complicated by multiple cranial nerve palsies. A case of SBO, complicated by multiple cranial nerve palsies, in which antimicrobial therapy was guided by gallium scintigraphy uptake, resulting in a favorable clinical course without recurrence, is reported. A 79-year-old man presented with right otalgia, otorrhea, hearing loss, and facial nerve paralysis. He was initially diagnosed with otitis media-related labyrinthitis and treated with antibiotics and corticosteroids. Two months later, the patient developed recurrent otorrhea and multiple cranial neuropathies. Contrast-enhanced computed tomography/magnetic resonance imaging revealed bone destruction and strong enhancement from the petrous apex to the clivus and nasopharynx. The patient was diagnosed with SBO and was administered intravenous antibiotics for 2 months. Oral antibiotics were continued for approximately 3 months post-discharge. Gallium-67 scintigraphy revealed near-complete resolution 5 months after discharge; accordingly, oral antibiotics were discontinued at that time. No recurrences were observed during 18 months of follow-up. This case highlights the importance of considering SBO in patients with cranial neuropathies, even when initial middle ear findings improve. Long-term culture-directed antibiotics guided by functional imaging, such as gallium scintigraphy, can optimize treatment, prevent recurrence, and improve outcomes in severe cases.
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BibTeX
@article{takeda2026gallium,
title = {{Gallium Scintigraphy-Guided Discontinuation of Antibiotics in Skull Base Osteomyelitis: A Case Report.}},
author = {Hiroki Takeda and Momoko Ise and Ryota Kiwaki and Takemasa Terao and Minori Natsumeda and Yorihisa Orita},
journal = {Journal of otology},
year = {2026},
month = oct,
doi = {10.26599/joto.2026.9540074},
url = {https://europepmc.org/article/MED/42996651},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Gallium Scintigraphy-Guided Discontinuation of Antibiotics in Skull Base Osteomyelitis: A Case Report.
AU - Hiroki Takeda
AU - Momoko Ise
AU - Ryota Kiwaki
AU - Takemasa Terao
AU - Minori Natsumeda
AU - Yorihisa Orita
PY - 2026
DA - 2026/10/01
JO - Journal of otology
DO - 10.26599/joto.2026.9540074
UR - https://europepmc.org/article/MED/42996651
AB - Skull base osteomyelitis (SBO) is a rare and potentially life-threatening infection often complicated by multiple cranial nerve palsies. A case of SBO, complicated by multiple cranial nerve palsies, in which antimicrobial therapy was guided by gallium scintigraphy uptake, resulting in a favorable clinical course without recurrence, is reported. A 79-year-old man presented with right otalgia, otorrhea, hearing loss, and facial nerve paralysis. He was initially diagnosed with otitis media-related labyrinthitis and treated with antibiotics and corticosteroids. Two months later, the patient developed recurrent otorrhea and multiple cranial neuropathies. Contrast-enhanced computed tomography/magnetic resonance imaging revealed bone destruction and strong enhancement from the petrous apex to the clivus and nasopharynx. The patient was diagnosed with SBO and was administered intravenous antibiotics for 2 months. Oral antibiotics were continued for approximately 3 months post-discharge. Gallium-67 scintigraphy revealed near-complete resolution 5 months after discharge; accordingly, oral antibiotics were discontinued at that time. No recurrences were observed during 18 months of follow-up. This case highlights the importance of considering SBO in patients with cranial neuropathies, even when initial middle ear findings improve. Long-term culture-directed antibiotics guided by functional imaging, such as gallium scintigraphy, can optimize treatment, prevent recurrence, and improve outcomes in severe cases.
SN - 1672-2930
SN - 2524-1753
ER -