Malignant otitis externa in an infant with selective IgA deficiency: a case report

Area of Science:

• Pediatric Infectious Diseases
• Immunology
• Otolaryngology

Background:

• Malignant otitis externa (MOE) is a severe necrotizing infection of the external auditory canal, typically seen in the elderly with diabetes.
• Infantile MOE is exceptionally rare, with limited documented cases and treatment protocols.

Observation:

• A neonate presented with clinical signs consistent with MOE.
• Subsequent investigations revealed the infant had selective IgA deficiency, an uncommon immunodeficiency.

Findings:

• The neonate was treated with oral ciprofloxacin, achieving clinical improvement.
• Despite successful treatment, the infant developed significant sequelae including external auditory canal stenosis, pinna deformity, persistent facial nerve palsy, temporal bone erosion, and hearing loss.

Implications:

• This case represents the first reported instance of MOE in a patient with selective IgA deficiency.
• It is also the first report detailing the use of ciprofloxacin for MOE in an infant.
• The findings underscore the potential for severe outcomes and the need for vigilant monitoring in infants with MOE, particularly those with underlying immunodeficiencies.