(337) Nontuberculous Mycobacterial Skull Base Osteomyelitis: Case Report and Literature Review

Monday, October 2, 2023

2:45 PM – 3:45 PM East Coast USA Time

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Presenting Author(s)

JM

Jake Patrick Morgan, MD

Resident Physician
University of Alabama At Birmingham
Birmingham, Alabama, United States

Co-Author(s)

AT

Ashwini Tilak, MD

University of Alabama at Birmingham, AL, USA
HA

Harpreet Arora, MD

University of Alabama at Birmingham, AL, USA
TM

Todd McCarty, MD

University of Alabama at Birmingham, USA

Senior Author(s)

EW

Erika Walsh, MD

Assistant Professor
University of Alabama at Birmingham
Birmingham, Alabama, United States

Disclosure(s):

Jake Patrick Morgan, MD: No relevant relationships to disclose.

Erika Walsh, MD: No relevant relationships to disclose.

Introduction: This case report details the presentation and treatment course of a case of an 80-year-old woman with a history of hypogammaglobinemia treated with intravenous immunoglobulin and chronic rhinosinusitis (CRS) who developed left-sided otitis media found to be caused by nontuberculous mycobacteria (NTM) that progressed to anterior and lateral skull base osteomyelitis. The following description serves to highlight the diagnostic challenge that NTM-mediated otologic conditions presents and suggest possible treatment options for an otherwise rare pathogen.

Methods: We performed a thorough chart review of the patient’s clinical course from the time she originally presented to clinic for evaluation of CRS in October, 2016 through her most recent follow-up appointment in January, 2022. Here we have placed specific attention upon the patient’s clinical course, pertinent surgeries, culture results, and antibiotic treatment regimens.

Results: The patient presented to clinic for treatment of chronic suppurative otitis media in the setting of a persistent tympanic membrane perforation after myringotomy tube removal and underwent left tympanomastoidectomy. Afterward, a culture of her left middle meatus demonstrated Mycobacterium chelonae/abscessus group, and the patient was started initially on IV amikacin and PO linezolid until therapy was stopped. She developed delayed graft failure and was found to have skull base osteomyelitis, which was treated with IV antibiotics and HBO. She eventually underwent left canal-wall-down mastoidectomy prior to starting a three-drug antibiotic course consisting of IV amikacin, oral linezolid and oral omadacycline. Ear cultures eventually confirmed Mycobacterium abscessus.

Conclusions: NTM-mediated otomastoiditis and skull base osteomyelitis is a rare entity that represents a diagnostic challenge. This case reports emphasizes the importance of considering NTM-mediated otologic disease in patients with chronic symptoms that fail to respond to both antibiotic and surgical therapy and introduces the use of omadacycline as a treatment consideration for such patients.