Aspergilluspetrous apicitis associated with cerebral and peritubular abscesses in an immunocompetent man

Abstract

Invasive fungal disease should be considered early in the course of skull base osteomyelitis that is clinically unresponsive to empirical broad spectrum antibiotics. This paper highlights the role of tissue biopsy in diagnosis, and the efficacy of voriconazole therapy without the need for radical surgery.

Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America

“…When invasion begins in the external auditory canal, infection has been called malignant otitis externa. Tissue-invasive Aspergillus otitis should be treated with prolonged systemic antifungals [448], preferably with voriconazole, usually preceded by surgical debridement [496][497][498][499]. Colonization of the middle ear and mastoid by Candida, Aspergillus, or other molds can occur in patients with chronic otitis media in the presence of a perforated tympanic membrane, usually following multiple surgical procedures and many courses of antibacterial agents.…”

Osteomyelitis caused by Aspergillus species: a review of 310 reported cases

“…Among the extrapulmonary locations, bone is rarely involved. Osteomyelitis caused by Aspergillus species is an infection that is often neglected, and data concerning risk factors, therapies and outcome are lacking . Therefore, in order to improve our knowledge of this unusual infection, we reviewed the data presented in the literature concerning this type of IA.…”

Mycological study on cholesteatoma keratin obtained during primary mastoid surgery

“…Invasive fungal disease causing intracranial complications have been described following surgery on an ear with chronic suppurative otitis media. 19 This flare-up was described as a 'forest fire phenomenon', in which the manipulation of previously quiescent fungi leads to activation and invasiveness. 20 In addition, a non-invasive fungal-related entity was recently reported following cholesteatoma surgery.…”

“…However, fungal diseases have been detected upon operating on a contaminated ear. Invasive fungal disease causing intracranial complications have been described following surgery on an ear with chronic suppurative otitis media 19 . This flare-up was described as a ‘forest fire phenomenon’, in which the manipulation of previously quiescent fungi leads to activation and invasiveness 20 .…”