Odontoid peg and skull base osteomyelitis presenting as Streptococcus pneumoniae meningitis in diabetes mellitus

Abstract

Skull base osteomyelitis (SBO) is a severe infection that is most frequently seen in elderly patients with diabetes. It is associated with high morbidity and mortality rates despite intensive antibiotic therapy. This condition, which often has a subtle course and nonspecific symptoms, is difficult to diagnose clinically. Meningitis is a rare presentation of this uncommon infection. This case report describes a 65-year-old man with type 2 diabetes who presented acutely with Streptococcus pneumoniae meningitis and was diagnosed with skull base osteomyelitis, retropharyngeal abscess, cervical spine osteomyelitis and discitis. The literature on SBO was reviewed and management discussed.