Aspergillus mastoiditis in acquired immunodeficiency syndrome.

OBJECTIVE

This study aimed to analyze the clinical presentation, diagnosis, management, and results of treatment in a series of three patients with acquired immunodeficiency syndrome (AIDS) in whom Aspergillus mastoiditis developed. This study also aimed to compare these aspects of Aspergillus mastoiditis in patients with AIDS with three additional cases present in the current literature. A classification system for fungal infections of the ear and temporal bone is proposed.

STUDY DESIGN

The study design was a retrospective case review.

SETTING

The study was conducted at multiple tertiary referral centers.

PATIENTS

Three individuals with diagnosed AIDS and mastoiditis resulting from culture-proven Aspergillus were studied.

INTERVENTION

Patients were treated with both medical and surgical methods including local and systemic antimicrobial/antifungal agents and mastoidectomy.

MAIN OUTCOME MEASURES

These measures included return of facial nerve function, control/resolution of disease, and survival.

RESULTS

All three patients in this series initially presented with otalgia and otorrhea and intact facial nerve function. Facial nerve paresis developed in all patients between 5 and 12 weeks after initial symptoms. Paresis uniformly improved or resolved after mastoidectomy. Two patients treated with systemic antifungal therapy and prompt surgical debridement after development of facial palsy had full resolution of infection. One patient had full recovery of facial paresis and the other had partial recovery. The third patient was lost to follow-up after initial treatment with antimicrobials and surgery and died 3 months later without a clear etiology.

CONCLUSIONS

Aspergillus mastoiditis is an unusual infection in patients with AIDS. Because of its rarity, fungal mastoiditis in immunocompromised individuals can result in a significant delay in diagnosis and treatment. The decision between conservative antimicrobial therapy and aggressive surgical treatment also can present a therapeutic challenge in the management of these life-threatening infections, especially in patients with existing immunodeficiency and illness. Early surgical debridement followed by antimicrobial therapy may be life preserving in this patient population.