Images in clinical medicine | Volume 36, Article 337, 25 Aug 2020 | 10.11604/pamj.2020.36.337.20814

Unusual manifestation of fungal malignant external otitis

Mafalda da Silva Ferreira, Clara Silva

Corresponding author: Mafalda Silva Ferreira, ENT Department, Coimbra University Hospital, Coimbra, Portugal

Received: 25 Oct 2019 - Accepted: 21 Nov 2019 - Published: 25 Aug 2020

Domain: Infectious disease,Otolaryngology (ENT)

Keywords: External otitis, malignant external otitis, fungal external otitis

©Mafalda da Silva Ferreira et al. Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cite this article: Mafalda da Silva Ferreira et al. Unusual manifestation of fungal malignant external otitis. Pan African Medical Journal. 2020;36:337. [doi: 10.11604/pamj.2020.36.337.20814]

Available online at: https://www.panafrican-med-journal.com/content/article/36/337/full

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Images in clinical medicine

Unusual manifestation of fungal malignant external otitis

Unusual manifestation of fungal malignant external otitis

Mafalda da Silva Ferreira, Clara Silva

 

1Mafalda.sf@hotmail.com

 

 

&Corresponding author
Mafalda Silva Ferreira, ENT Department, Coimbra University Hospital, Coimbra, Portugal

 

 

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Malignant external otitis (MEO) is a fatal disease of the external auditory canal and temporal bone. The infection begins as an external otitis that later spreads and turns into an osteomyelitis of the temporal bone. It has an extremely aggressive behavior and poor prognosis. It mainly affects immunocompromised men over 60 years old. Diabetes is the most common risk factor and Pseudomonas Aeruginosa is the organism responsible for 90% of all cases. These pictures represent a case of an extremely invasive fungal MEO in a 59 years old man. It was a patient with a history of MEO on the right ear, with a poorly controlled type II diabetes and a chronic renal insufficiency. He presented with one month complaint of severe left ear pain and discharge. In otoscopy (A) we observed otorrhea and granulation tissue at the osseocartilaginous junction. Swab culture from the ear canal showed the presence of Aspergillus Flavus, an uncommon organism. Technetium and gallium scans reveled an intense uptake within the left temporal bone. During the treatment with intravenous voriconazole and vancomycin the patient developed paresis of VI nerve (B). Head MRI showed significant inflammatory soft tissue in mastoids, with an extensive inflammatory process involving the skull base (C). Cranial nerves can be damage when the infection spreads along skull base. The patient remains under antifungal treatment and with a special concern about pain relieving.

 

 

Figure 1: (A,B,C) fungal malignant external otitis

 

 

 

 

 

 

 

 

 

 

 

 

Images in clinical medicine

Unusual manifestation of fungal malignant external otitis

Images in clinical medicine

Unusual manifestation of fungal malignant external otitis

Images in clinical medicine

Unusual manifestation of fungal malignant external otitis

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Key words

External otitis

Malignant external otitis

Fungal external otitis

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Unusual manifestation of fungal malignant external otitis