title: Coccidioides immitis subperiosteal abscess of the temporal bone in a child.
abstract: A destructive granulomatous lesion of the temporal bone caused by Coccidioides immitis disseminated from a pulmonary lesion was found in a 4-year-old immunocompetent child. To our knowledge, it is the first case of coccidioidomycosis of the temporal bone reported in the world literature. The child presented with pain in her right ear and a 6-month history of intermittent fever, which partially responded to multiple courses of antibiotics. A tender erythematous postauricular swelling consistent with a subperiosteal abscess subsequently developed over 1 month. A mastoidectomy showed granulation tissue with pockets of purulence, and histologic evaluation of the specimen revealed spherules of C immitis, later verified by culture. The patient responded to intravenous amphotericin B therapy, without evidence of disease recurrence. Coccidioides immitis is endemic in regions of the Southwestern United States, with extremely infectious characteristics and relative resistance to medical therapy. Coccidioidomycosis should be considered in the differential diagnosis of a granulomatous lesion of the temporal bone.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, University of California, San Diego, School of Medicine, USA.
authors.forename: W S
authors.initials: WS
authors.lastname: Low
authors.forename: A B
authors.initials: AB
authors.lastname: Seid
authors.forename: S M
authors.initials: SM
authors.lastname: Pransky
authors.forename: D B
authors.initials: DB
authors.lastname: Kearns
mesh_terms: D000038:Abscess / Q000382:microbiology* / Q000601:surgery; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D002675:Child, Preschool; D003047:Coccidioidomycosis / Q000382:microbiology* / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008172:Lung Diseases, Fungal / Q000382:microbiology*; D010522:Periostitis / Q000382:microbiology* / Q000601:surgery; D013701:Temporal Bone / Q000382:microbiology*
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B