Fungal malignant otitis externa caused by Alternaria chlamydospora: first case report. Issue 1 (February 2015)

• Record Type: Journal Article
• Authors: Korres, George; Meletiadis, Joseph; Delides, Alexander; Antoniadou, Anastasia; Petrikkos, George; Zerva, Loukia; Yiotakis, Ioannis; Siopi, Maria; Kalogeropoulou, Eleni; Georgantis, Ilias; Nikolopoulos, Thomas P.
• Is Part Of: JMM case reports. Volume 2:Issue 1(2015)
• Publication Date: 2015-02
• Subjects: Alternaria sp. -- diabetes type II -- fungal malignant otitis externa -- otalgia -- otorrhoea -- skull base osteomyelitis -- voriconazole; Medical microbiology -- Periodicals; 616.9041
• DOI: 10.1099/jmmcr.0.000021
• Languages: English
• ISSNs: 2053-3721

Abstract

Abstract : Introduction: Malignant otitis externa (MOE) is a rare clinical entity, usually observed in diabetic or immunosuppressed patients, with serious morbidity due to associated osteomyelitis, cranial nerve palsies and intracranial infections. Pseudomonas aeruginosa is the main pathogen in over 95 % of cases; Aspergillus species and Candida albicans have also been implicated in fungal MOE. Case presentation: Α 79‐year‐old male with type 2 diabetes with otalgia, otorrhoea and granulation tissue occupying the right external ear canal was diagnosed with MOE. Direct microscopy of a tissue biopsy specimen taken from the granulation tissue revealed septate branching hyphae and chlamydospores. An olivaceous‐black colony cultured within 3 days at 30 °C was identified microscopically as Alternaria sp. and molecularly as Alternaria chlamydospora using the restriction fragment length polymorphism pattern of the internal transcribed spacer (ITS) region on the basis of the 570 bp ITS amplicon, a Bst UI largest band of 578 bp and absence of the Taq I 114 bp band. The patient was unresponsive to ciprofloxacin, whereas the pain was relieved after 2 weeks of voriconazole treatment followed by surgical debridement. Conclusion: We present, we believe, the first reported case of MOE for which Alternaria sp. seems to be the causative pathogen. A high index of suspicion was needed in order to reach the diagnosis. We recommend taking tissue cultures when a high‐risk patient is not responsive to the initial antibiotic treatment, as fungal MOE could be a repercussion of unsuccessfully treated bacterial otitis externa or it could represent a de novo presentation of fungal disease.