Blastomyces Induced Otomastoiditis With Local Soft Tissue Invasion: A Case Report

Area of Science:

• Mycology
• Infectious Diseases
• Otolaryngology

Background:

• Blastomycosis dermatitidis is a fungus endemic to certain areas, typically causing pulmonary infections.
• Disseminated blastomycosis presenting as otomastoiditis is exceptionally rare, even in immunocompetent individuals.
• Mastoiditis with soft tissue extension requires prompt diagnosis and management.

Observation:

• An immunocompetent 27-year-old male with occupational dust and soil exposure presented with otalgia, hearing loss, and facial paralysis.
• Magnetic resonance imaging revealed extensive infection involving the mastoid and surrounding soft tissues.
• Surgical intervention (tympanoplasty and mastoidectomy) was performed due to the extent of the disease.

Findings:

• Postoperative treatment with itraconazole effectively halted soft tissue invasion and resolved infection manifestations.
• The case highlights the potential for Blastomycosis dermatitidis to cause rare otomastoiditis presentations.
• Fungal infections should be considered in the differential diagnosis of persistent otalgia with facial paralysis, irrespective of immune status.

Implications:

• Early identification of uncommon fungal infections like blastomycosis is crucial for preventing complications such as hearing loss and local tissue invasion.
• Clinicians should maintain a high index of suspicion for fungal causes of otologic symptoms, particularly with relevant environmental exposures.
• This case underscores the importance of considering disseminated fungal infections beyond typical pulmonary presentations.