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A rare case of tympanostomy tube otorrhea: Pigmentiphaga
Samuel J Rubin1, Claire M Lawlor2, Gi Soo Lee3
1Department of Otolaryngology and Communication Disorders, Boston Children's Hospital, Boston, MA, USA; Department of Otolaryngology, Boston Medical Center, Boston, MA, USA.
Abstract:
Tympanostomy tube otorrhea (TTO) is a common complication of tympanostomy tubes. The most common bacteria associated with TTO include Haemophalis influenza, Moraxella catarrhalis, Streptococcus pneumoniae, Staphylococcus aureus, and Pseudomonas aeruginosa. We present the first case of a 9 year-old female with a history of 22q11 syndrome, hemifacial microsomia, Tetralogy of Fallot, and hearing aid dependence with left-sided profound sensorineural and right-sided moderate conductive hearing loss who presented with TTO caused by the bacteria Pigmentiphaga daeguenesis/kulla, a gram-negative bacteria often found in soil. This patient's otorrhea did not respond to typical otic antibiotic formulations, but was ultimately treated successfully with intramuscular ceftriaxone. We describe the natural history, presentation and management for a case of TTO caused by a rare bacteria from the genus Pigmentiphaga.
Insights
Tympanostomy tube otorrhea (TTO) can be caused by rare soil bacteria. A 9-year-old girl with multiple health conditions was successfully treated with ceftriaxone for a Pigmentiphaga infection.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Microbiology
Background:
- Tympanostomy tube otorrhea (TTO) is a frequent complication following tympanostomy tube insertion.
- Commonly implicated bacteria include Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae, Staphylococcus aureus, and Pseudomonas aeruginosa.
Observation:
- A 9-year-old female with 22q11 syndrome, hemifacial microsomia, Tetralogy of Fallot, and hearing aid dependence presented with TTO.
- The otorrhea was caused by Pigmentiphaga daeguenesis/kulla, a gram-negative soil bacterium, which is a rare pathogen for TTO.
- The patient's condition did not improve with standard topical antibiotic treatments.
Findings:
- This case represents the first documented instance of TTO caused by bacteria from the genus Pigmentiphaga.
- Intramuscular ceftriaxone was administered, leading to a successful resolution of the otorrhea.
- The study details the natural history, clinical presentation, and management strategy for this unusual TTO case.
Implications:
- Highlights the importance of considering rare bacterial pathogens in refractory TTO cases.
- Suggests that systemic antibiotics may be necessary for TTO caused by uncommon bacteria like Pigmentiphaga.
- Underscores the need for tailored treatment approaches in patients with complex medical histories and TTO.
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