Aspergillus flavus malignant external otitis in a diabetic patient: case report and literature review.
Infection
; 48(2): 193-203, 2020 Apr.
Article
em En
| MEDLINE
| ID: mdl-32036556
ABSTRACT
PURPOSE:
Malignant external otitis is an aggressive and potentially life-threatening infection. This rare disorder is typically caused by Pseudomonas aeruginosa and affects almost exclusively elderly diabetic patients. However, fungal malignant external otitis have been identified, especially in immunocompromised hosts.METHODS:
We report a rare case of invasive malignant external otitis caused by Aspergillus flavus in a diabetic patient without other underlying immunosuppression. A review of Aspergillus spp. malignant external otitis since voriconazole became the first line for invasive aspergillosis was performed.RESULTS:
A 72-year-old man with diabetes mellitus developed invasive malignant external otitis with a vascular involvement. The patient was treated with empiric courses of antibiotics until a fungal infection was diagnosed. Proven Apsergillus infection was based on histopathological examination and isolation of A. flavus from culture of osteo-meningeal biopsies. Despite optimal antimicrobial therapy with voriconazole, the patient presented with cerebral infarction in the setting of an angioinvasive fungal infection leading to a fatal outcome. From a review of the literature, we found 39 previously published cases of proven Aspergillus spp. malignant external otitis treated with new triazoles.CONCLUSION:
Given our experience and the literature review, a fungal etiology should be considered early in the course of malignant external otitis unresponsive to a conventional broad spectrum antibiotic therapy, with the need for a tissue biopsy to confirm the diagnosis.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Otite Externa
/
Aspergilose
/
Aspergillus flavus
/
Complicações do Diabetes
Tipo de estudo:
Prognostic_studies
Limite:
Aged
/
Humans
/
Male
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article