International Journal of STD & AIDS 1992; 3: 214


Malignant otitis extema in a patient with AIDS D G Daniels MBBS MRCP, M R Nelson MBBS MRCP, S E Barton MD MRCOG and B G Gazzard MD FRCP Department ofHIVIGenitourinary Medicine, St Stephen's Clinic andWestminster Hospital, London, UK Keywords: Malignant otitis externa, acquired immunodeficiency syndrome

In immunocompetent patients malignant otitis externa is an uncommon condition but has been reported particularly in patients with diabetes mellitus. It is defined as infection of the external auditory meatus (usually due to Pseudomonas aeruginosa), leading to rapidly progressive destruction of surrounding tissues, which may result in progressive deafness and cranial nerve palsies due to infiltration of the skull basel. Although a single case of malignant external otitis secondary to Pseudomonas aeruginosa has been reported in a paediatric patient with AIDS2, we describe the first case in an adult infected with the human immunodeficiency virus (HIV). CASE REPORT A 44-year-old homosexual man presented to the department of Genitourinary Medicine with a one week history of ear pain and diminished hearing on the right-hand side. One year previously AIDS was diagnosed following an episode of Pneumocystis carinii pneumonia. A diagnosis of otitis media was made, and he was commenced on erythromycin 500 mg four times a day. Four days later he presented to the Accident and Emergency department with severe otalgia, a purulent discharge from the right auditory meatus and sudden onset of right facial weakness. He had also noted unsteadiness of gait. Examination revealed a complete right lower motor neurone facial nerve palsy, total right-sided deafness and horizontal nystagmus on left lateral gaze. Auroscopy revealed a profuse purulent discharge from the right ear. Culture of this pus yielded a heavy growth of Pseudomonas aeruginosa. A cerebral CT scan showed diffuse cerebral atrophy, with soft tissue infiltration within the right auditory canal extending to the middle ear, and partial opacification of the right petrous air cells. There was no evidence of bone destruction. Correspondence to: Dr B G Gazzard, HIV/GUM Department, The Kobler Centre, St Stephen's Clinic, 369 Fulham Road, London SW10, UK

Treatment with intravenous ceftazidime 1 g four times a day, and metronidazole 400 mg four times a day, resulted in rapid resolution of the ear pain and partial recovery of the right facial nerve palsy. Unfortunately the patient developed cryptosporidial diarrhoea and died 3 months later. DISCUSSION The primary immunological deficit in HIV infection is CD4 cell depletion". However B-cell deficits predisposing to bacterial infections also occur and may be clinically important", An increased tendency to pseudomonal infections in patients with AIDS has recently been reported". This case demonstrates that it is important to gain early microbiological sampling of all external auditory meatal discharges so that correct therapy is commenced as soon as possible. Without treatment, malignant otitis externa is rapidly progressive and can lead to severe sequelae as demonstrated in this case. References 1 Hickey SA, Ford GR, O'Connor AF, Eykyn SJ, Sonkser PH. Treating malignant otitis with oral ciprafloxacin. 8MJ 1989; 229:550-1 2 Scott GB, Buik BE, Leterman JS, et al. Acquired immunodeficiency syndrome in infants. N Engl J Med 1984;310: 76-81 3 Seligman M, Pinching AJ, Rosen FS. Perspectives: immunology of human immunodeficiency virus infection and the acquired immunodeficiency syndrome: an update. Ann Intern Med 1987;107:234-42 4 Lane HC, Masur H, Edgar LC, Whalen G, Roor AH, Fauci AS. Abnormalities of B cell activation and immunoregulation in patients with the acquired immunodeficiency syndrome. N Engl J Med 1983;309:453-8 5 Nelson MR, Shanson DC, Barter GJ, Hawkins DA, Gazzard BG. Pseudomonas septicaemia associated with HIV. AIDS 1991;5:761-3

(Accepted 9 March 1992)

Downloaded from at CORNELL UNIV on September 26, 2016

Malignant otitis externa in a patient with AIDS.

International Journal of STD & AIDS 1992; 3: 214 CASE REPORT Malignant otitis extema in a patient with AIDS D G Daniels MBBS MRCP, M R Nelson MBBS M...
91KB Sizes 0 Downloads 0 Views