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Aspergillus flavus malignant external otitis in a diabetic patient: case report and literature review

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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Authors and Affiliations

  1. Service de Maladies Infectieuses Et Tropicales, APHP, Hôpital Bichat-Claude Bernard, 46, rue Henri Huchard, 75018, Paris, France

    Maud Pichon, Véronique Joly & Yazdan Yazdanpanah

  2. INSERM, IAME, UMR 1137, Université Paris Diderot, Paris, France

    Véronique Joly & Yazdan Yazdanpanah

  3. COMUE Sorbonne Paris Cité, Paris, France

    Véronique Joly & Yazdan Yazdanpanah

  4. Laboratoire de Parasitologie-Mycologie, APHP, Hôpital Bichat-Claude Bernard, 46, rue Henri Huchard, 75018, Paris, France

    Nicolas Argy & Sandrine Houze

  5. Faculté de Pharmacie de Paris, Université Paris Descartes, COMUE Sorbonne Paris Cité, Paris, France

    Nicolas Argy & Sandrine Houze

  6. MERIT UMR 216, Institut de Recherche pour le Développement, Université Paris Descartes, Paris, France

    Nicolas Argy & Sandrine Houze

  7. Laboratoire de Mycologie, APHP, Hôpital Saint Louis, 1 avenue Claude Vellefaux, 75010, Paris, France

    Stéphane Bretagne & Alexandre Alanio

  8. Université Paris Diderot, Paris, France

    Stéphane Bretagne

  9. Sorbonne Paris Cité, Paris, France

    Stéphane Bretagne

  10. Laboratoire de Pathologie, APHP, Hôpital Lariboisière, 2, rue Ambroise Paré, 75010, Paris, France

    Michel Wassef

  11. Service D’Oto-Rhino-Laryngologie, APHP, Hôpital Lariboisière, 2, rue Ambroise Paré, 75010, Paris, France

    Benjamin Verillaud

  12. Service de Médecine Polyvalente, Centre Hospitalier Victor Dupouy, 69, Rue du Lieutenant-Colonel-Prudhon, 95100, Argenteuil, France

    Maud Pichon

Authors
  1. Maud Pichon
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  2. Véronique Joly
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  3. Nicolas Argy
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  4. Sandrine Houze
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  5. Stéphane Bretagne
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  6. Alexandre Alanio
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  7. Michel Wassef
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  8. Benjamin Verillaud
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  9. Yazdan Yazdanpanah
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Corresponding author

Correspondence to Maud Pichon.

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Pichon, M., Joly, V., Argy, N. et al. Aspergillus flavus malignant external otitis in a diabetic patient: case report and literature review. Infection 48, 193–203 (2020). https://doi.org/10.1007/s15010-020-01394-8

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  • DOI: https://doi.org/10.1007/s15010-020-01394-8

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