Khoo Jing Hern, Zainon Izny Hafiz, Johari Hafizah Husna, Sachlin Ida Sadja'ah
Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia.
J Int Adv Otol. 2024 Nov 25;20(6):536-539. doi: 10.5152/iao.2024.231331.
Paecilomyces spp. are thermo-tolerant fungi found in decaying vegetables and soil. They can cause ocular, cutaneous, and miscellaneous infections. In otorhinolaryngology, most infections occur in the paranasal sinuses, while otological infection is uncommon.
We report a case of 41-year-old diabetic, male army officer with warm, fluctuant left temporal swelling and reduced hearing. Otoscopy revealed an edematous external auditory canal (EAC) with posterior wall sagging and bulging tympanic membrane. Computed tomography revealed subperiosteal temporal abscess extending intracranially. The pus was drained surgically via an otological and a neurosurgical approach, and pus sent for culture grew paecilomyces. He showed clinical improvement after receiving oral antifungal treatment postoperatively. Retrospectively, his occupation as an army officer and his diabetic immunocompromised state may have predisposed him to the infection.
Paecilomyces middle ear infection leading to intracranial involvement of such magnitude is yet to be reported, and we showcase its successful management through a combined surgical neuro-otology approach and oral antifungal therapy. Fungal ear infections can lead to severe extracranial and intracranial complications if inadequately treated. Differentiating it from cholesteatoma also presents a diagnostic challenge clinically and radiologically. While both can lead to intracranial complications, our patient's brief history and lack of prior ear symptoms contrast with that of cholesteatoma.
The rarity of neuro-otological paecilomyces infections emphasizes the need for awareness and early identification. It is vital to recognize such infections, and prompt surgical management with appropriate antifungal drugs is warranted to prevent disastrous outcomes.
拟青霉属是在腐烂蔬菜和土壤中发现的耐热真菌。它们可引起眼部、皮肤及其他感染。在耳鼻喉科，大多数感染发生在鼻窦，而耳部感染并不常见。
我们报告一例41岁的男性糖尿病军官病例，其左侧颞部有温热、波动感的肿胀且听力下降。耳镜检查显示外耳道水肿，后壁下垂，鼓膜膨出。计算机断层扫描显示颞骨骨膜下脓肿向颅内延伸。通过耳科和神经外科手术方法引流脓液，脓液培养出拟青霉。术后接受口服抗真菌治疗后，他的临床症状有所改善。回顾来看，他作为军官的职业以及糖尿病导致的免疫功能低下状态可能使他易患该感染。
拟青霉引起中耳感染并导致如此严重的颅内累及情况尚未见报道，我们展示了通过联合神经耳科手术方法和口服抗真菌治疗对其成功的治疗。真菌性耳部感染若治疗不当可导致严重的颅外和颅内并发症。在临床和影像学上，将其与胆脂瘤相鉴别也具有诊断挑战性。虽然两者都可导致颅内并发症，但我们患者的简短病史及既往无耳部症状与胆脂瘤不同。
神经耳科拟青霉感染的罕见性强调了提高认识和早期识别的必要性。认识到此类感染至关重要，及时进行手术治疗并使用适当的抗真菌药物以防止出现灾难性后果是必要的。
