Fungal malignant otitis externa due to Scedosporium apiospermum

Area of Science:

• Infectious Diseases
• Mycology
• Otolaryngology

Background:

• Malignant otitis externa (MOE) is a severe infection of the external auditory canal extending to the skull base.
• Fungal infections are implicated in MOE, with Aspergillus species being the most common pathogen.
• MOE predominantly affects immunocompromised individuals, particularly those with end-stage acquired immunodeficiency syndrome (AIDS) and hematologic malignancies.

Observation:

• This report details a unique case of fungal MOE caused by Scedosporium apiospermum in a 21-year-old male with end-stage AIDS.
• Unlike typical MOE, the infection in this patient originated in the mastoid air cells or middle ear, not the external auditory canal.
• Granulation tissue, a common feature in MOE, was notably absent in this immunocompromised patient.

Findings:

• Scedosporium apiospermum is identified as a causative agent of fungal MOE in an AIDS patient.
• The atypical presentation underscores the varied clinical manifestations of fungal MOE in severely immunocompromised hosts.
• Treatment relies on surgical debridement and antifungal therapy, primarily amphotericin B.

Implications:

• This case expands the spectrum of fungal pathogens responsible for MOE.
• It highlights the critical role of underlying immune status in MOE presentation and prognosis.
• Effective management necessitates addressing both the fungal infection and the patient's severe immunodeficiency.