Chronic Skull Osteomyelitis following Skin Graft: A Case Report and Literature Review

Osteomyelitis (OM) is a rare but serious inflammation of the bone resulting from an infection caused by an organism. Chronic osteomyelitis is an unusual inflammatory process involving multiple osseous sites. In children, osteomyelitis can be either acute or chronic.
This case concerns a 3-year-old girl whose medical history includes an acid attack suffered 3 years ago. She began treatment for the restoration of her scalp hair, but five weeks later, she presented at our clinic with a high-grade fever and infectious discharge from the commissure of the skull following a scalp expansion graft. Microbiologic and radiologic work-ups were conducted, and the patient was given an experimental antibiotic treatment. The brain spiral CT scan without contrast and brain MR imaging showed chronic osteomyelitis of her cranial bones. After 25 days patient was discharged with a course of oral antibiotics to continue at home.
Although chronic skull base osteomyelitis is rare, it is a very serious condition that should be considered in the differential diagnosis of any patient who has suffered trauma to the cranial bones or undergone skin grafts or hair restoration on their scalp. Thorough evaluation is mandatory in these cases.