title: Novel use of a swimming pool biocide in the treatment of a rare fungal mastoiditis.
abstract: OBJECTIVE
  To describe an extremely rare fungal mastoiditis caused by Lecythophora hoffmannii, its recalcitrant behavior to therapy, and eventual successful treatment with adjunctive therapy using polyhexamethylene biguanide (a common swimming pool biocide).
  
  
  METHODS
  Case report and review of literature of human Lecythophora hoffmannii infections.
  
  
  METHODS
  Medline database was searched using the keywords Lecythophora and hoffmannii. All articles that described Lecythophora hoffmannii as the cause of human infection at any site were identified. Literature and patient's records were considered for complete data review and extraction.
  
  
  RESULTS
  We present the second known case in the literature of a human infection with Lecythophora hoffmannii. We also present the process to definitively identify and then to successfully eradicate this unusual fungal infection using polyhexamethylene biguanide as adjunctive treatment.
  
  
  CONCLUSIONS
  Successful treatment of a chronic Lecythophora hoffmannii fungal mastoiditis involved a combination of radical surgical removal of all apparent infected tissue along with local treatments with polyhexamethylene biguanide, a common swimming pool biocide agent under the brand name Baquacil (Avecia, Manchester, United Kingdom). Given the prolonged course of treatment, this report particularly stresses the importance of concurrent surgery combined with creative local antimicrobial therapy to eliminate an unusual fungal infection in an immunocompetent host.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: Christopher Y
authors.initials: CY
authors.lastname: Chang
authors.forename: Wiley A
authors.initials: WA
authors.lastname: Schell
authors.forename: John R
authors.initials: JR
authors.lastname: Perfect
authors.forename: Gregory F
authors.initials: GF
authors.lastname: Hulka
mesh_terms: D001645:Biguanides / Q000627:therapeutic use*; D002648:Child; D004202:Disinfectants / Q000627:therapeutic use*; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008417:Mastoiditis / Q000188:drug therapy* / Q000601:surgery; D009181:Mycoses / Q000188:drug therapy* / Q000601:surgery; D013551:Swimming Pools; D014871:Water Microbiology
chemical_list: D001645:Biguanides; D004202:Disinfectants; C031233:polihexanide