Aspergillus mastoiditis, presenting with unexplained progressive otalgia, in an immunocompetent (older) patient.
Aspergillus mastoiditis and skull-base osteomyelitis are extremely rare, even in immunocompromised patients. We report a case of an 81-year-old immunocompetent man, who underwent a mastoidectomy because of unexplained, progressive otalgia in spite of a noninflamed and air-containing middle-ear space. Histopathology yielded Aspergillus fumigatus. When confronted with otitis with an unexpected clinical course a high index of suspicion is required to facilitate early diagnosis and appropriate therapy of a potential lethal Aspergillus infection, even in immunocompetent patients. This seems to be more so in older patients with an open middle-ear cavity and/or when there is facial nerve involvement.
van Tol
Aukje
A
Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
van Rijswijk
Jeroen
J
D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000008:administration & dosage; D001228:Aspergillosis / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology / Q000601:surgery; D001232:Aspergillus fumigatus; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D004433:Earache / Q000209:etiology*; D006801:Humans; D007121:Immunocompetence; D008297:Male; D008416:Mastoid / Q000473:pathology / Q000601:surgery; D008417:Mastoiditis / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology / Q000601:surgery; D008825:Miconazole / Q000008:administration & dosage; D011182:Postoperative Care; D011743:Pyrimidines / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed; D014230:Triazoles / Q000008:administration & dosage; D018058:Tympanic Membrane Perforation / Q000175:diagnosis / Q000276:immunology / Q000473:pathology / Q000601:surgery; D065819:Voriconazole
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D008825:Miconazole; D065819:Voriconazole