Necrotizing external otitis caused byAspergillus fumigatus: computed tomography and high resolution magnetic resonance imaging in an AIDS patient

Abstract

Most necrotizing (malignant) external otitis (NEO) occurs in diabetic patients and is commonly caused byPseudomonas aeruginosa. We report an acquired immunodeficiency syndrome (AIDS) patient with NEO caused byAspergillus fumigatusin which computed tomography (CT) showed destructive petrous bone involvement and magnetic resonance imaging (MRI) of the ear discovered extensive soft tissue and facial nerve involvement. Dedicated MRI studies of the ear in this type of pathology provide new insights relating to nerve dysfunction, that cannot be obtained with CT.

Fungal Malignant Otitis Externa Due to Scedosporium Apiospermum

“…Only 10 of the 23 patients with fungal MOE initially presented with otitis externa without signs of middle ear or mastoid involvement (cases 1,4,7,13,15,16,19,20,22, and 23).…”

“…All 6 of these patients were young (14,20,21,27,27, and 41 years of age in cases 22, 16,21,8,20, and 18, respectively) and were severely immunocompromised (4 with end-stage AIDS, 1 with severe neutropenia from chemotherapy for acute lymphoblastic leukemia, and 1 with graft-versus-host disease following bone marrow transplantation). An additional 7 patients died of other causes within a year of their fungal MOE.…”

Complicated Necrotizing Otitis Externa Progressing to Coalescent Mastoiditis and Temporal Lobe Abscess

“…While typically caused by Pseudomonas aeruginosa in elderly diabetic patients, it has also been reported in immunocompromised patients secondary to Aspergillus, thus requiring addition of antifungal coverage. 1,2 Prompt diagnosis and initiation of antipseudomonal antimicrobials are vital in preventing life-threatening complications such as osteomyelitis, cranial nerve palsies, and intracerebral abscesses. 3,4 The diagnosis of necrotizing otitis externa is made clinically as patients present with otalgia and otorrhea, along with infectious sequelae, such as fevers and chills.…”

A rare and sinister variant of a common ailment: Fungal malignant otitis externa

“…The most common pathogen identified is Pseudomonas aeruginosa and up until a decade ago fungal MOE was considered extremely rare (4,5). There are however a number of cases in the literature reporting fungal organisms causing MOE, including Asperigillus species (6-8), Candida parapsilosis (9), Candida ciferri, Pseudoallescheria boydii, Malassezia sympodialis and Scedosporium apiospermum (5,10). …”