title: Necrotizing external otitis in a patient caused by Klebsiella pneumoniae.
abstract: Necrotizing external otitis is a potentially life-threatening infection involving the temporal and adjacent bones. The most frequent pathogen is attributed to Pseudomonas aeruginosa, but is rarely caused by Klebsiella pneumoniae. Recently, we encountered a 47-year-old diabetic man with a swollen obliterated external ear canal with granulation tissue on the right ear. Image study demonstrated skull base osteomyelitis, epidural abscess and cerebral venous sinus thrombi. It was later proved to be necrotizing external otitis caused by Klebsiella pneumoniae. He then underwent craniotomy for drainage of the epidural abscess, followed by intravenous ciprofloxacin and metronidazole for 2 consecutive weeks until both pus and blood cultures depicted no growth of pathogens. Based on this case, synergistic antibiotic therapy using a third-generation cephalosporin or quinolone (ciprofloxacin), accompanied by metronidazole, and even a short-term aminoglycoside is recommended for the treatment of severe Klebsiella-induced necrotizing external otitis. Surgical intervention should be limited without shedding of the pathogens.
authors.affiliation: Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, 1 Chang-Te St., Taipei, Taiwan.
authors.forename: Ting-Hua
authors.initials: TH
authors.lastname: Yang
authors.forename: Shuo-Tzung
authors.initials: ST
authors.lastname: Kuo
authors.forename: Yi-Ho
authors.initials: YH
authors.lastname: Young
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003399:Craniotomy; D020802:Epidural Abscess / Q000382:microbiology / Q000601:surgery; D006801:Humans; D007710:Klebsiella Infections / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D007711:Klebsiella pneumoniae; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010032:Otitis Externa / Q000175:diagnosis / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D013701:Temporal Bone / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents