Service de Maladies Infectieuses Et Tropicales, APHP, Hôpital Bichat-Claude Bernard, 46, rue Henri Huchard, 75018, Paris, France.
Service de Médecine Polyvalente, Centre Hospitalier Victor Dupouy, 69, Rue du Lieutenant-Colonel-Prudhon, 95100, Argenteuil, France.
Infection. 2020 Apr;48(2):193-203. doi: 10.1007/s15010-020-01394-8. Epub 2020 Feb 8.
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.
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.
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.
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.
恶性外耳炎是一种侵袭性的、潜在威胁生命的感染。这种罕见的疾病通常由铜绿假单胞菌引起，几乎只影响老年糖尿病患者。然而，已经发现了真菌性恶性外耳炎，特别是在免疫功能低下的宿主中。
我们报告了一例罕见的糖尿病患者发生侵袭性黄曲霉恶性外耳炎的病例，该患者无其他潜在免疫抑制。回顾了伏立康唑成为侵袭性曲霉病一线治疗药物以来，由黄曲霉引起的 Aspergillus spp. 恶性外耳炎的病例。
一名 72 岁男性，患有糖尿病，发生侵袭性恶性外耳炎并伴有血管受累。患者在接受经验性抗生素治疗，直到诊断出真菌感染。确诊为 Aspergillus 感染是基于组织病理学检查和从骨脑膜活检中分离出黄曲霉。尽管给予了伏立康唑的最佳抗菌治疗，但患者在血管侵袭性真菌感染的情况下出现脑梗死，导致致命结局。通过文献回顾，我们发现了 39 例先前发表的经证实的 Aspergillus spp. 恶性外耳炎病例，这些病例均采用新型三唑类药物治疗。
鉴于我们的经验和文献回顾，在常规广谱抗生素治疗无效的恶性外耳炎患者中，应早期考虑真菌病因，需要进行组织活检以确诊。
