Introduction
Necrotising otitis externa (NOE) is a rare infection of the ear canal with frequent bone erosion. This study’s objective is to describe the different features of NOE as well as its management in an ear-nose-throat department. We also tried to identify the particularities of the fungal infection.
Patients and methods
It is an observational cohort that included all the patients hospitalised for the management of NOE. The study was carried out in the ear-nose-throat Department of Mahdia University Hospital in Tunisia between January 2006 and december 2019.
Results
A total of 40 patients were included. The mean age was 65 ± 12.9 years and the sex ratio was 0.9. Ninety percent of the patients included were diabetics. The most common signs found were oedema of the external canal (97.5%) and auricular discharge (92.5%). The main pathogen isolated was
Pseudomonas aeruginosa
(61.7%). Fungi were isolated in 9 cases (26.47%). Computed tomography was performed for 32 patients (80%). Bone erosion was seen in 26 cases (81.3%). The main complications were cerebral venous thrombosis, retropharyngeal abscess and cerebral empyema. Thirty one patients received only antibiotics, 2 received only antifungal treatment, and 7 received both antibiotics and antifungal treatment. All patients had a favorable outcome. Univariate analysis showed a higher median erythrocyte sedimentation rate was associated with fungal infections. No other differences were noted.
Conclusion
Our management protocol seems to be efficient since all patients had initial favorable outcome. A higher median erythrocyte sedimentation rate was associated with fungal infections.
Le syndrome d'hypersensibilité médicamenteuse ou Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) est une toxidermie rare mais sévère. Nous rapportons trois observations de DRESS syndromes secondaires à la prise de carbamazipine dans deux cas et de salazopyrine dans un cas. Le délai moyen entre la prise médicamenteuse et la survenue du DRESS syndrome était de six semaines. Le médicament incriminé était arrêté d'une façon définitive dans tous les cas. Une corticothérapie par voie générale était instaurée chez tous les patients devant l'atteinte hépatique sévère. L’évolution était favorable avec disparation des lésions cutanées et normalisation du bilan hépatique. Le diagnostic du syndrome DRESS doit être évoqué devant un tableau associant une éruption fébrile et des signes systémiques faisant suite à une prise médicamenteuse. La précocité du diagnostic est fondamentale pour l'arrêt définitif des médicaments suspects. Le traitement n'est pas bien codifié mais repose actuellement sur la corticothérapie générale.
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