Tuberculous Skull Base Osteomyelitis With Cerebral Venous Sinus Thrombosis in an Immunocompetent Adolescent: A Case Report

Skull-base osteomyelitis is a rare yet lethal entity. It is infrequently observed among immunocompetent children and young adults, and Mycobacterium is much less common among the various bacterial and fungal etiological causes noted. We report a rare case of a 17-year immunocompetent girl who presented with complaints of head and neck pain and restricted neck movements. The analysis of her cerebrospinal fluid revealed a lymphocytic pleocytosis with elevated protein levels. Imaging studies revealed erosion of the occipital condyle and clivus and an extradural collection extending into the prevertebral and paravertebral spaces until the second cervical vertebra level. In addition to this life-threatening complication, the potential involvement of the cerebral venous sinuses is also of particular interest-a diagnosis of tubercular meningitis with skull base osteomyelitis based on the CSF and imaging findings. The drastic improvement in the initiation of anti-tubercular therapy emphasizes the need for prompt and early initiation of anti-tubercular therapy in endemic areas. The clinical picture, diagnosis, and treatment of tubercular skull-base osteomyelitis are further discussed, and pertinent literature has been reviewed.