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Invasive otitis externa due to Aspergillus species: case report and review
1Geisinger Medical Center, Danville, Pennsylvania.
Abstract:
Aspergillus flavus, an unusual cause of malignant external otitis, was identified in pure culture of tissue from two patients in which histologic examinations demonstrated branching septate hyphae invading the temporal bone. Both patients presented with protracted external ear pain. Multiple attempts at treatment with topical agents (polymyxin B sulfate-neomycin sulfate-hydrocortisone), oral agents (cephalexin and ciprofloxacin), and parenteral agents (ceftazidime and tobramycin) were unsuccessful before definitive diagnosis was made. Treatment with amphotericin B, followed by a more protracted course of itraconazole, resulted in an apparent cure for these patients. Follow-up examination at 15 months after the discontinuation of therapy with itraconazole demonstrated no recurrence of infection. Previously reported cases have predominantly involved immunocompromised persons, and these cases are summarized.
Insights
Aspergillus flavus can cause malignant otitis externa, a severe ear infection. Antifungal treatment with amphotericin B and itraconazole successfully cured two patients resistant to other therapies.
Area of Science:
- Mycology
- Infectious Diseases
- Otolaryngology
Background:
- Malignant otitis externa (MOE) is a severe infection of the external ear canal.
- Aspergillus flavus is an uncommon but significant pathogen in MOE cases.
- Previous MOE cases primarily affected immunocompromised individuals.
Observation:
- Two patients presented with severe, persistent external ear pain due to MOE.
- Histopathology revealed Aspergillus flavus with hyphae invading the temporal bone.
- Initial treatments with topical, oral, and parenteral antibiotics were ineffective.
Findings:
- Definitive diagnosis of Aspergillus flavus infection was established.
- Treatment with amphotericin B followed by itraconazole led to apparent cure.
- No recurrence was observed 15 months post-itraconazole therapy.
Implications:
- Highlights Aspergillus flavus as a causative agent of MOE, even in non-immunocompromised patients.
- Demonstrates the efficacy of systemic antifungal therapy for refractory MOE.
- Emphasizes the importance of timely diagnosis and appropriate antifungal treatment for MOE.
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