Fungal malignant otitis externa:  pitfalls, diagnosis, and treatment.
OBJECTIVE
Oral voriconazole is a viable alternative modality treatment to traditionally used intravenous vancomycin in the treatment of malignant otitis externa (MOE).


BACKGROUND
The incidence of MOE is on the rise, more so in Saudi Arabia where diabetes mellitus is endemic. Although Pseudomonas aeruginosa is the most common offending organism, we are observing an increasing number of fungal MOE, in particular, Aspergillus species. The clinical findings in these patients can be quite different from those of the classic gram-negative bacteria.


METHODS
Chart review of patients with a diagnosis of MOE who underwent oral voriconazole treatment.


RESULTS
Three cases of Aspergillus MOE are reported in detail, pointing the pitfalls in clinical findings, diagnosis, and management of this entity.


CONCLUSIONS
Oral voriconazole proved to be an excellent alternative modality treatment in this population of patients with MOE.
Saudi Aramco Medical Services, Dhahran, Kingdom of Saudi Arabia. antoine.tarazi.1@aramco.com
Antoine E
AE
Tarazi
Jaffar A
JA
Al-Tawfiq
Rifat F
RF
Abdi
D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D001230:Aspergillus / Q000302:isolation & purification; D005260:Female; D006801:Humans; D008297:Male; D009181:Mycoses / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology; D010032:Otitis Externa / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D011743:Pyrimidines / Q000627:therapeutic use*; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use*; D065819:Voriconazole
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole