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Abstract

Introduction:

Malignant otitis externa (MOE) is a rare clinical entity, usually observed in diabetic or immunosuppressed patients, with serious morbidity due to associated osteomyelitis, cranial nerve palsies and intracranial infections. is the main pathogen in over 95 % of cases; species and have also been implicated in fungal MOE.

Case presentation:

Α 79‐year‐old male with type 2 diabetes with otalgia, otorrhoea and granulation tissue occupying the right external ear canal was diagnosed with MOE. Direct microscopy of a tissue biopsy specimen taken from the granulation tissue revealed septate branching hyphae and chlamydospores. An olivaceous‐black colony cultured within 3 days at 30 °C was identified microscopically as sp. and molecularly as using the restriction fragment length polymorphism pattern of the internal transcribed spacer (ITS) region on the basis of the 570 bp ITS amplicon, a UI largest band of 578 bp and absence of the I 114 bp band. The patient was unresponsive to ciprofloxacin, whereas the pain was relieved after 2 weeks of voriconazole treatment followed by surgical debridement.

Conclusion:

We present, we believe, the first reported case of MOE for which sp. seems to be the causative pathogen. A high index of suspicion was needed in order to reach the diagnosis. We recommend taking tissue cultures when a high‐risk patient is not responsive to the initial antibiotic treatment, as fungal MOE could be a repercussion of unsuccessfully treated bacterial otitis externa or it could represent a presentation of fungal disease.

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2015-02-01
2019-11-15
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