Author:
M Smida1, A Meherzi2, H Chouaieb1, M Chatti1, M Ben Seif1, R Hajlaoui1, M Abdelkefi2, A Fathallah1*
Author address:
1Department of Parasitology Mycology, Farhat Hached University Hospital, Sousse, Tunisia
2Department of ENT, Farhat Hached University Hospital, Sousse, Tunisia
Full conference title:
10th Advances Against Aspergillosis and Mucormycosis
Date: 2 February 2022
Abstract:
Introduction:
Otomycosis is a fungal infection of the external canal but can affect the middle ear. It is increasingly found in clinical practice. It can be the result of superinfection of chronic bacterial infection of the external canal or middle ear. The most common fungus is Aspergillus spp.
Purpose:
Here, we aim to describe a case of bilateral invasive Aspergillus otomycosis in a diabetic patient.
Case report:
We report a case of a 56-year-old woman who consulted for a severe bilateral otalgia. The past medical history was significant for a long-standing type 2 diabetes mellitus treated by insulin, hypertension, kidney failure and hypothyroidism.
The onset was 3 months with bilateral otalgia associated to a fetid otorrhea. The patient was treated with a prolonged course of antibiotics without clinical improvement. She was admitted in ENT department. ENT clinical exam revealed a well-calibrated macerated External acoustic meatus with granulomas on the left side associated with profuse otorrhea making difficult to see the tympanic membrane. Cranial nerves examination were normal. The initial bacteriological and mycological examinations were both negative. CT scan showed a bilateral necrotizing external otitis with signs of aggression. Treatment consisted on: Tazocillin 4g/day and Ciprofloxacin 500mg/day with daily local care for 14 witout any clinical improvement. Then we swiched by Fortum 500mg/day, Ciprofloxacin 500mg/day and Vancomycin 250mg/day without any clinical or biological improvement. A new biopsy was performed. Mycological culture grew Aspergillus flavus and histological examination showed the presence of mycelial filaments. We treated by Voriconazole with regression of all clinical and biologic signs. There were a remarkable response with a follow up of 6 months.
Conclusion:
Although otomycosis is frequently encountered, diagnosis remain difficult and challenging because of its non-specific symptoms. There are several predisposing factors including diabetes, steroids, habitual instrumentation, dermatitis, and immunocompromising conditions. Timely diagnosis and management are important to avoid complications.
Abstract Number: 18
Conference Year: 2022
Link to conference website: https://aaam2022.org/
URL Conference abstract: