Central skull base osteomyelitis due to nasopharyngeal infection

Background Skull base osteomyelitis (SBO) is a rare but life-threatening disease occurring as a complication of malignant otitis externa, and accompanied by venous sinus thrombosis, meningitis, abscess, cranial neuropathies, and carotid invasion as complications. Central SBO may originate from a paranasal infection, such as sphenoidal or ethmoidal sinusitis without associated external otitis. Case Report We describe a 36-year-old Sri Lankan male with central SBO presenting with multiple embolic infarctions and meningitis caused by a nasopharyngeal Klebsiella infection that had invaded the left internal carotid artery. Despite complications, such as endogenous endophthalmitis, abscesses in the brain parenchyma, and mycotic aneurysms in cerebral vessels, the patient recovered after 8 weeks of intensive antibiotics treatment except for a remnant mycotic aneurysmal dilatation in the internal carotid artery. Conclusion This is the first report of central SBO caused by a nasopharyngeal Klebsiella infection, which invaded the left internal carotid artery and led to multiple complications.