#35801慢性中耳炎引起的TMJ和颅底真菌骨髓炎

Bok Eum Kim
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引用次数: 0

摘要

背景和目的慢性中耳炎(Chronic otitis media, COM)是一种中耳炎症性疾病。COM的症状为耳痛、颅内并发症。颅底骨髓炎(SBO)可能是基于COM的感染传播而发生的。在本文中,我们报告了一位未经治疗的COM患者被诊断为SBO。方法a -67岁男性以左侧颞下颌关节疼痛就诊。他服用了非甾体抗炎药,他的症状有所缓解,但没有消失。CT未见异常。但他的左颞下颌关节有常见的疼痛。他被诊断为左颞下颌关节痛。用药后,左侧颞下颌关节疼痛消失。6个月后再次就诊,同一部位出现刺痛感。CT显示左侧TMJ糜烂改变。他被诊断为左颞下颌关节骨关节炎,并开了阿莫西林、酮酸等药物。然而,他的剧痛一直持续着。结果CRP为49.1。MRI显示左髁不均匀强化。他被转介到耳鼻喉科,并进行了左侧乳突切除术。当切除标本进行微生物培养时,发现念珠菌,最终诊断为SBO。结论对不典型颞下颌关节疼痛的患者,应进行详细的病史记录。未经治疗的COM会扩散,导致SBO。未经治疗的SBO会导致死亡。如果COM患者有全身性疾病史,真菌骨髓炎可能发展到颅底,导致骨改变。CT/MRI诊断非常重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
#35801 Fungal osteomyelitis of TMJ and skull base caused by chronic otitis media

Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)

Background and Aims

Chronic otitis media (COM) is an inflammatory disease of the middle ear. The symptoms of COM are ear pain, intracranial complication. Skull base osteomyelitis (SBO) may occur by transmission of infection based on COM. In this paper, we present a patient with untreated COM who was diagnosed with SBO.

Methods

A-67-year-old man visited our clinic with left TMJ pain. He had taken NSAIDs, and his symptoms had been relieved but not disappeared. CT showed no abnormal finding. But he showed familiar pain in the left TMJ. He was diagnosed with left TMJ arthralgia. After medication, the pain in the left TMJ was disappeared. 6 months later, he re-visited clinic and presented with pricking pain in the same area. CT revealed erosive change in left TMJ. He was diagnosed with left TMJ osteoarthritis and prescribed medicines including amoxicillin, ketorolac. However, his severe pain had been persisted.

Results

CRP is 49.1. A MRI showed heterogeneous enhancement in the left condyle. He was referred to ENT and left mastoidectomy was performed. When the microbial cultures of resected specimens were performed, candida was found, which led to the final diagnosis of SBO.

Conclusions

In case of atypical pain on TMJ, it is necessary to take a careful history taking. Untreated COM can spread, leading to SBO. Untreated SBO can lead to death. If COM patient has a history of systemic diseases, fungal osteomyelitis may develop up to the skull base, leading to bony change. It is important to diagnose by using CT/MRI.
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