Chronic Osteomyelitis of the Cranial Vault in an Adolescent Female: A Case Report

We report an 18-year-old female patient who developed left temporal headache and fever one month after administration of isotretinoin for acne. Imaging studies demonstrated osteolytic change in the left frontal bone, and the lesion showed gadolinium contrast enhancement. Biopsy confirmed the diagnosis of osteomyelitis, and the symptoms improved after 8 months of medication with antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs). However, the pain recurred when isotretinoin was resumed. Isotretinoin sometimes causes excessive inflammation, which may have been the reason for the osteomyelitis in this case. Although osteomyelitis is usually caused by bacterial infection, a non-bacterial mechanism should also be suspected if the condition is resistant to antibiotics.