21 April 2019 : Case report
Fungal Malignant Otitis Externa Involves a Cascade of Complications Culminating in Pseudoaneurysm of Internal Maxillary Artery: A Case Report
Unusual clinical course
Haseeb Ahmad Chaudhary1DEF*, Wanis H. Ibrahim1DEF, Zohaib Yousaf1EF, Ibrahim Yusuf Abubeker1F, Anand Kartha1EDOI: 10.12659/AJCR.913469
Am J Case Rep 2019; 20:562-566
Abstract
BACKGROUND: Pseudomonal infection is the most common cause of malignant otitis externa (MOE), which typically affects elderly diabetic patients. Fungi are a rare cause of MOE. MOE can be life-threatening if not recognized and treated promptly. It can result in a wide spectrum of complications, including skull-base osteomyelitis, cranial nerve palsy, cerebral venous thrombosis, and brain abscess. Pseudoaneurysm formation of the intracranial vessels is a life-threatening complication of MOE that is seldom reported in the literature.
CASE REPORT: We report the case of a 66-year-old diabetic man with MOE who was initially treated with antipseudomonal antibiotics after negative initial culture results. His MOE resulted in a cascade of complications, including facial nerve palsy, skull base osteomyelitis, and sigmoid sinus thrombosis, and culminated in left maxillary artery pseudoaneurysm formation resulting in massive epistaxis and hemodynamic instability. Endovascular embolization resulted in a successful obliteration of the pseudoaneurysm. A subsequent functional endoscopic sinus surgical (FESS) tissue biopsy confirmed Candida glabrata as the etiological agent. The patient was successfully treated with antibiotics and antifungal and anticoagulation therapy, and was discharged home in good condition.
CONCLUSIONS: A high index of suspicion for the diagnosis of fungal MOE, particularly in intractable cases of MOE with negative initial cultures, should be maintained. Pseudoaneurysm formation is a life-threatening complication of MOE that is seldom reported in the literature and should be suspected in any patient with MOE who presents with epistaxis or intracranial bleeding.
Keywords: Aneurysm, False, Candida glabrata, otitis externa, Anti-Bacterial Agents, Antifungal Agents, Diabetes Mellitus, Type 2, Embolization, Therapeutic, Epistaxis, Maxillary Artery, Pseudomonas Infections, Risk Assessment
In Press
Case report
Orbital Metastasis as the First Manifestation of Hepatocellular Carcinoma, and Its Effective Treatment with...Am J Case Rep In Press; DOI: 10.12659/AJCR.944002
Case report
Uncommon Presentation of Systemic Lupus Erythematosus: Intracranial Mass Lesions as the First ManifestationAm J Case Rep In Press; DOI: 10.12659/AJCR.942877
Case report
Rare Pathogens in Peritoneal Dialysis-Associated Peritonitis: A Comprehensive Case Study and Guideline ReviewAm J Case Rep In Press; DOI: 10.12659/AJCR.943953
Case report
Adult Female Patient with Untreated Truncus Arteriosus Type I and Torsion of Small Bowel Gastrointestinal S...Am J Case Rep In Press; DOI: 10.12659/AJCR.943604
Most Viewed Current Articles
07 Mar 2024 : Case report
Neurocysticercosis Presenting as Migraine in the United StatesDOI :10.12659/AJCR.943133
Am J Case Rep 2024; 25:e943133
10 Jan 2022 : Case report
A Report on the First 7 Sequential Patients Treated Within the C-Reactive Protein Apheresis in COVID (CACOV...DOI :10.12659/AJCR.935263
Am J Case Rep 2022; 23:e935263
19 Jul 2022 : Case report
Atlantoaxial Subluxation Secondary to SARS-CoV-2 Infection: A Rare Orthopedic Complication from COVID-19DOI :10.12659/AJCR.936128
Am J Case Rep 2022; 23:e936128
23 Feb 2022 : Case report
Penile Necrosis Associated with Local Intravenous Injection of CocaineDOI :10.12659/AJCR.935250
Am J Case Rep 2022; 23:e935250