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Aspergillus mastoiditis, presenting with unexplained progressive otalgia, in an immunocompetent (older) patient.

van Tol A, van Rijswijk J - Eur Arch Otorhinolaryngol (2008)

Bottom Line: Aspergillus mastoiditis and skull-base osteomyelitis are extremely rare, even in immunocompromised patients.When confronted with otitis with an unexpected clinical course a high index of suspicion is required to facilitate early diagnosis and appropriate therapy of a potential lethal Aspergillus infection, even in immunocompetent patients.This seems to be more so in older patients with an open middle-ear cavity and/or when there is facial nerve involvement.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.

ABSTRACT
Aspergillus mastoiditis and skull-base osteomyelitis are extremely rare, even in immunocompromised patients. We report a case of an 81-year-old immunocompetent man, who underwent a mastoidectomy because of unexplained, progressive otalgia in spite of a noninflamed and air-containing middle-ear space. Histopathology yielded Aspergillus fumigatus. When confronted with otitis with an unexpected clinical course a high index of suspicion is required to facilitate early diagnosis and appropriate therapy of a potential lethal Aspergillus infection, even in immunocompetent patients. This seems to be more so in older patients with an open middle-ear cavity and/or when there is facial nerve involvement.

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Related in: MedlinePlus

Axial CT scan of the right temporal bone showing complete opacification of the mastoid air cells, an air-containing middle ear and swelling of the soft tissues surrounding the ear
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Fig1: Axial CT scan of the right temporal bone showing complete opacification of the mastoid air cells, an air-containing middle ear and swelling of the soft tissues surrounding the ear

Mentions: Initial laboratory workup showed signs of an infection [ESR 46 mm/h, CRP 21.3 mg/l, normal WBC (8.6 × 109/l; 16% lymphocytes)]. Liver enzymes were normal. Fasting blood sugar was 6.1 mmol/l. Anti-dsDNA, ENA, anti-proteinase3 and anti-myeloperoxidase were all negative. Tone and speech audiometry showed a superimposed conductive hearing loss of the right ear. Because of the ununderstood invalidating earache (not matching with the quite external auditory canal, tympanic membrane and middle ear) a computed tomography (CT) scan was planned. This scan (1 week later) demonstrated complete opacification of the right mastoid air cells, swelling of the soft tissues surrounding the ear but no signs of bony erosion (Fig. 1).Fig. 1


Aspergillus mastoiditis, presenting with unexplained progressive otalgia, in an immunocompetent (older) patient.

van Tol A, van Rijswijk J - Eur Arch Otorhinolaryngol (2008)

Axial CT scan of the right temporal bone showing complete opacification of the mastoid air cells, an air-containing middle ear and swelling of the soft tissues surrounding the ear
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2734251&req=5

Fig1: Axial CT scan of the right temporal bone showing complete opacification of the mastoid air cells, an air-containing middle ear and swelling of the soft tissues surrounding the ear
Mentions: Initial laboratory workup showed signs of an infection [ESR 46 mm/h, CRP 21.3 mg/l, normal WBC (8.6 × 109/l; 16% lymphocytes)]. Liver enzymes were normal. Fasting blood sugar was 6.1 mmol/l. Anti-dsDNA, ENA, anti-proteinase3 and anti-myeloperoxidase were all negative. Tone and speech audiometry showed a superimposed conductive hearing loss of the right ear. Because of the ununderstood invalidating earache (not matching with the quite external auditory canal, tympanic membrane and middle ear) a computed tomography (CT) scan was planned. This scan (1 week later) demonstrated complete opacification of the right mastoid air cells, swelling of the soft tissues surrounding the ear but no signs of bony erosion (Fig. 1).Fig. 1

Bottom Line: Aspergillus mastoiditis and skull-base osteomyelitis are extremely rare, even in immunocompromised patients.When confronted with otitis with an unexpected clinical course a high index of suspicion is required to facilitate early diagnosis and appropriate therapy of a potential lethal Aspergillus infection, even in immunocompetent patients.This seems to be more so in older patients with an open middle-ear cavity and/or when there is facial nerve involvement.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.

ABSTRACT
Aspergillus mastoiditis and skull-base osteomyelitis are extremely rare, even in immunocompromised patients. We report a case of an 81-year-old immunocompetent man, who underwent a mastoidectomy because of unexplained, progressive otalgia in spite of a noninflamed and air-containing middle-ear space. Histopathology yielded Aspergillus fumigatus. When confronted with otitis with an unexpected clinical course a high index of suspicion is required to facilitate early diagnosis and appropriate therapy of a potential lethal Aspergillus infection, even in immunocompetent patients. This seems to be more so in older patients with an open middle-ear cavity and/or when there is facial nerve involvement.

Show MeSH
Related in: MedlinePlus