Malignant external otitis due to Aspergillus flavus with fulminant dissemination to the lungs

Malignant external otitis secondary to aspergillus infection is rare, and only 10 cases have been reported in the literature. Nine of 10 patients responded to therapy and survived their infection. There have been no previous reports of dissemination of Aspergillus species from the ear to other organs. We describe a case of malignant external otitis due to Aspergillus flavus that disseminated hematogenously to the lungs. The result was an overwhelming, miliary pulmonary infection, which progressed very rapidly to respiratory failure and death. Pathological examination of lung tissue revealed multiple microabscesses and hyphal elements that had invaded the lung parenchyma from small pulmonary arteries.