title: Malignant otitis externa caused by Malassezia sympodialis.
abstract: BACKGROUND
  Malignant otitis externa caused by fungal infections is rare. A review of the literature showed only 9 cases, and the causative fungus in all cases was Aspergillus. This article reports an unusual case caused by Malassezia sympodialis.
  
  
  METHODS
  A 53-year-old man with non-insulin dependent diabetes presented with malignant otitis externa. He deteriorated despite treatment with intravenous antipseudomonal therapy and surgical debridement. Microbiologic tests revealed M. sympodialis. He responded rapidly to intravenous amphotericin.
  
  
  RESULTS
  Systemic human infections caused by M. sympodialis have not been reported. M. furfur systemic infection is rare and has been associated lipid hyperalimentation by means of a central catheter. Only 1 other case of M. fungemia without these associated risk factors has been reported.
  
  
  CONCLUSIONS
  The first case of malignant otitis externa caused by M. sympodialis is presented. It highlights the difficulty of initial biologic diagnosis and the need for lipid-enriched media to grow this fastidious organism.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Royal Perth Hospital, Wellington St, Perth WA 6000, Australia.
authors.forename: F C
authors.initials: FC
authors.lastname: Chai
authors.forename: K
authors.initials: K
authors.lastname: Auret
authors.forename: K
authors.initials: K
authors.lastname: Christiansen
authors.forename: P W
authors.initials: PW
authors.lastname: Yuen
authors.forename: D
authors.initials: D
authors.lastname: Gardam
mesh_terms: D000666:Amphotericin B / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage; D003881:Dermatomycoses / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis; D005500:Follow-Up Studies; D006801:Humans; D008290:Malassezia / Q000187:drug effects / Q000302:isolation & purification*; D008297:Male; D008875:Middle Aged; D010032:Otitis Externa / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B