{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,17]],"date-time":"2026-01-17T08:35:27Z","timestamp":1768638927846,"version":"3.49.0"},"reference-count":19,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n<jats:title>Background: <\/jats:title>\n<jats:p>During the past 2 years, the use of systemic corticosteroids has increased due to COVID-19 atypical pneumonia management. Similarly, an increase in mycotic infection cases has been reported during the same period as a consequence of immunosuppression caused by corticosteroid overuse. Mycotic clival osteomyelitis is a rare clinical entity which presumably has increased its incidence during the pandemic.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st2\">\n<jats:title>Case Description: <\/jats:title>\n<jats:p>A 52-year-old woman who presented persistent headaches and unexplained weight loss after being hospitalized due to COVID-19 pneumonia treated with intravenous corticosteroids. Head computed tomography and magnetic resonance imaging showed extensive osteomyelitis at the clival region with no brain parenchyma involvement. Surgical excision through navigation-guided transnasal transclival endoscopic extended approach was performed for surgical debridement. Histopathological analysis revealed angulated hyphae, suggestive of <jats:italic>Aspergillosis<\/jats:italic>. Systemic antifungal treatment was administered for 30 consecutive days. Afterward, she was discharged without any remarkable neurological findings, reassessed during follow-up.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st3\">\n<jats:title>Conclusion: <\/jats:title>\n<jats:p>The COVID-19 pandemic has had an effect on the reemergence of mycotic infections due to corticosteroid immunosuppression. Clival osteomyelitis secondary to mycotic infection is an exclusion diagnosis that we encourage to be highly suspected within the persisting COVID-19 pandemic.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_668_2022","type":"journal-article","created":{"date-parts":[[2022,10,7]],"date-time":"2022-10-07T06:43:02Z","timestamp":1665124982000},"page":"459","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Mycotic clival osteomyelitis secondary to immunosuppression by SARS-CoV-2"],"prefix":"10.25259","volume":"13","author":[{"given":"Julio C\u00e9sar","family":"Delgado-Arce","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Centro M\u00e9dico Arturo Montiel Rojas, Instituto de Seguridad Social del Estado de M\u00e9xico y Municipios, M\u00e9xico-Toluca, Metepec,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabiola Alejandra","family":"Becerra-Arciniega","sequence":"additional","affiliation":[{"name":"Department of Radiology, Centro M\u00e9dico Arturo Montiel Rojas, Instituto de Seguridad Social del Estado de M\u00e9xico y Municipios, M\u00e9xico-Toluca, Metepec,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Escamilla-Ch\u00e1vez","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Centro M\u00e9dico Arturo Montiel Rojas, Instituto de Seguridad Social del Estado de M\u00e9xico y Municipios, M\u00e9xico-Toluca, Metepec,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hector Sebasti\u00e1n","family":"VelascoTorres","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Centro M\u00e9dico Arturo Montiel Rojas, Instituto de Seguridad Social del Estado de M\u00e9xico y Municipios, M\u00e9xico-Toluca, Metepec,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pablo David","family":"Guerrero-Suarez","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Centro M\u00e9dico Arturo Montiel Rojas, Instituto de Seguridad Social del Estado de M\u00e9xico y Municipios, M\u00e9xico-Toluca, Metepec,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaime Jes\u00fas","family":"M\u00e1rtinez-Anda","sequence":"additional","affiliation":[{"name":"Department of Neurological Center, ABC Medical Center, Tlaxcala Santa Fe, Mexico."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2022,10,7]]},"reference":[{"key":"10.25259\/SNI_668_2022\/ref-1","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1007\/s00701-018-3768-5","article-title":"Nocardial clival osteomyelitis secondary to sphenoid sinusitis: An atypical skull base infection","volume":"161","author":"Abou-Al-Shaar","year":"2019","journal-title":"Acta Neurochir (Wien)"},{"key":"10.25259\/SNI_668_2022\/ref-2","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1177\/0194599819838834","article-title":"Efficacy of HRCT imaging vs SPECT\/CT scans in the staging of malignant external otitis","volume":"161","author":"Balakrishnan","year":"2019","journal-title":"Otolaryngol Head Neck Surg"},{"key":"10.25259\/SNI_668_2022\/ref-3","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1159\/000097858","article-title":"Invasive sphenoidal aspergillosis: Successful treatment with sphenoidotomy and voriconazole","volume":"69","author":"Baumann","year":"2007","journal-title":"ORL J Otorhinolaryngol Relat Spec"},{"key":"10.25259\/SNI_668_2022\/ref-4","doi-asserted-by":"crossref","first-page":"2221","DOI":"10.1007\/s00701-015-2564-8","article-title":"Endoscopic endonasal approach in invasive aspergillosis of the clivus in an immunocompetent patient","volume":"157","author":"Beer-Furlan","year":"2015","journal-title":"Acta Neurochir (Wien)"},{"key":"10.25259\/SNI_668_2022\/ref-5","first-page":"1310","article-title":"Central skull base osteomyelitis in patients without otitis externa: Imaging findings","volume":"24","author":"Chang","year":"2003","journal-title":"AJNR Am J Neuroradiol"},{"key":"10.25259\/SNI_668_2022\/ref-6","doi-asserted-by":"crossref","first-page":"404","DOI":"10.3174\/ajnr.A7015","article-title":"Skull base osteomyelitis: A comprehensive imaging review","volume":"42","author":"Chapman","year":"2021","journal-title":"AJNR Am J Neuroradiol"},{"key":"10.25259\/SNI_668_2022\/ref-7","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1111\/j.1368-5031.2004.0099.x","article-title":"Voriconazole for serious fungal infections","volume":"58","author":"Gothard","year":"2004","journal-title":"Int J Clin Pract"},{"key":"10.25259\/SNI_668_2022\/ref-8","first-page":"293","article-title":"Since January 2020 Elsevier has created a COVID-19 resource centre with free information in english and mandarin on the novel coronavirus COVID-19. 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