Objective:

To report a case of purulent meningitis presenting with spontaneous cerebrospinal fluid (CSF) rhinorrhea, where a clival chordoma was identified during surgical intervention despite initial imaging showing no definitive mass.

Approach:

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Key Findings:

• Persistent spontaneous CSF rhinorrhea can indicate an occult skull-base tumor.
• Preoperative MRI may not always reveal underlying tumors, leading to diagnostic delays.
• Histopathological examination confirmed the diagnosis of chordoma.

Interpretation:

Management of CSF leaks complicated by meningitis should focus on infection control while investigating potential underlying causes.

Limitations:

• Biochemical confirmation of CSF leakage was not obtained due to unavailability of specific assays.
• Initial imaging did not detect the clival mass, highlighting limitations in diagnostic imaging.

Conclusion:

This case emphasizes the need for thorough etiologic workup in patients with CSF leaks and meningitis, as occult tumors may be present despite negative imaging.