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Necrotizing external otitis in a patient caused by Klebsiella pneumoniae

Ting-Hua Yang1, Shuo-Tzung Kuo, Yi-Ho Young

  • 1Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, 1 Chang-Te St., Taipei, Taiwan.

European Archives of Oto-Rhino-Laryngology : Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : Affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
|December 27, 2005
PubMed

Insights

Necrotizing external otitis, a severe ear infection, can be caused by Klebsiella pneumoniae. This case highlights effective synergistic antibiotic treatment for this rare but dangerous pathogen.

Area of Science:

  • Infectious Diseases
  • Otolaryngology
  • Microbiology

Background:

  • Necrotizing external otitis (NEO) is a severe infection of the temporal bone, typically caused by Pseudomonas aeruginosa.
  • While rare, Klebsiella pneumoniae can also cause NEO, posing a significant threat, especially in immunocompromised individuals.

Observation:

  • A 47-year-old diabetic male presented with symptoms of NEO, including ear canal swelling and granulation tissue.
  • Imaging revealed extensive complications: skull base osteomyelitis, epidural abscess, and cerebral venous sinus thrombi.

Findings:

  • The patient's infection was confirmed to be caused by Klebsiella pneumoniae.
  • Successful treatment involved surgical drainage of the epidural abscess followed by a 2-week course of intravenous ciprofloxacin and metronidazole.

Implications:

  • This case underscores the importance of considering Klebsiella pneumoniae in severe NEO cases.
  • Synergistic antibiotic therapy, including cephalosporins or quinolones with metronidazole and potentially aminoglycosides, is recommended for severe Klebsiella-induced NEO.
  • Conservative surgical intervention, focusing on pathogen drainage, is advised.

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