Malignant Otitis Externa Complicated by Skull Base Osteomyelitis Presenting as Vernet's Syndrome with Central Venous Thrombosis

Skull base osteomyelitis (SBO) is a rare disease that often has delayed presentation in clinical settings. SBO is often misinterpreted as skull base malignancy, thus posing a challenge in diagnosis. We submit a case that presented with chronic otitis media with multiple cranial nerve palsies. His diagnosis was challenged in view of nonspecific imaging findings and odd presentation, which caused a delay in diagnosis. Methicillin-resistance coagulase-negative Staphylococcus (MRCONS) was isolated from the drained pus. MRCONS usually presents with an indwelling medical device or in severe burn cases. However, isolating and documenting organisms in SBO is needed for rare cases. A final diagnosis of SBO complicated with Vernet's syndrome and sigmoid sinus thrombosis was made. He made good recovery with microbial-specific antibiotics and drainage of abscess with the least improvement on cranial nerve palsies.