Beyond the Ear, the Hidden Threat of Paecilomyces Neuro-Otological Infection: A Case Report
Background: Paecilomyces spp. are thermo-tolerant fungi found in decaying vegetables and soil. They can cause ocular, cutaneous, and miscellaneous infections. In otorhinolaryngology, most infections occur in the paranasal sinuses, while otological infection is uncommon. Methods: We report a case...
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2024-11-01
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| Series: | Journal of International Advanced Otology |
| Online Access: | https://www.advancedotology.org/en/beyond-the-ear-the-hidden-threat-of-paecilomyces-neuro-otological-infection-a-case-report-131971 |
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| author | Jing Hern Khoo Izny Hafiz Zainon Hafizah Husna Johari Ida Sadja’ah Sachlin |
| author_facet | Jing Hern Khoo Izny Hafiz Zainon Hafizah Husna Johari Ida Sadja’ah Sachlin |
| author_sort | Jing Hern Khoo |
| collection | DOAJ |
| description | Background: Paecilomyces spp. are thermo-tolerant fungi found in decaying vegetables and soil. They can cause ocular, cutaneous, and miscellaneous infections. In otorhinolaryngology, most infections occur in the paranasal sinuses, while otological infection is uncommon.
Methods: We report a case of 41-year-old diabetic, male army officer with warm, fluctuant left temporal swelling and reduced hearing. Otoscopy revealed an edematous external auditory canal (EAC) with posterior wall sagging and bulging tympanic membrane. Computed tomography revealed subperiosteal temporal abscess extending intracranially. The pus was drained surgically via an otological and a neurosurgical approach, and pus sent for culture grew paecilomyces. He showed clinical improvement after receiving oral antifungal treatment postoperatively. Retrospectively, his occupation as an army officer and his diabetic immunocompromised state may have predisposed him to the infection.
Results: Paecilomyces middle ear infection leading to intracranial involvement of such magnitude is yet to be reported, and we showcase its successful management through a combined surgical neuro-otology approach and oral antifungal therapy. Fungal ear infections can lead to severe extracranial and intracranial complications if inadequately treated. Differentiating it from cholesteatoma also presents a diagnostic challenge clinically and radiologically. While both can lead to intracranial complications, our patient's brief history and lack of prior ear symptoms contrast with that of cholesteatoma.
Conclusion: The rarity of neuro-otological paecilomyces infections emphasizes the need for awareness and early identification. It is vital to recognize such infections, and prompt surgical management with appropriate antifungal drugs is warranted to prevent disastrous outcomes. |
| format | Article |
| id | doaj-art-fc6234260f2c4c8b9f178ab34b1a5a91 |
| institution | Kabale University |
| issn | 2148-3817 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | AVES |
| record_format | Article |
| series | Journal of International Advanced Otology |
| spelling | doaj-art-fc6234260f2c4c8b9f178ab34b1a5a912025-01-30T13:54:07ZengAVESJournal of International Advanced Otology2148-38172024-11-0120653653910.5152/iao.2024.231331Beyond the Ear, the Hidden Threat of Paecilomyces Neuro-Otological Infection: A Case ReportJing Hern Khoo0https://orcid.org/0009-0008-5737-371XIzny Hafiz Zainon 1https://orcid.org/0000-0002-0477-1107Hafizah Husna Johari2Ida Sadja’ah Sachlin3https://orcid.org/0000-0003-2825-3248Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Sultanah Bahiyah, Alor Setar, Kedah, MalaysiaDepartment of Otorhinolaryngology, Head and Neck Surgery, Hospital Sultanah Bahiyah, Alor Setar, Kedah, MalaysiaDepartment of Otorhinolaryngology, Head and Neck Surgery, Hospital Sultanah Bahiyah, Alor Setar, Kedah, MalaysiaDepartment of Otorhinolaryngology, Head and Neck Surgery, Hospital Sultanah Bahiyah, Alor Setar, Kedah, MalaysiaBackground: Paecilomyces spp. are thermo-tolerant fungi found in decaying vegetables and soil. They can cause ocular, cutaneous, and miscellaneous infections. In otorhinolaryngology, most infections occur in the paranasal sinuses, while otological infection is uncommon. Methods: We report a case of 41-year-old diabetic, male army officer with warm, fluctuant left temporal swelling and reduced hearing. Otoscopy revealed an edematous external auditory canal (EAC) with posterior wall sagging and bulging tympanic membrane. Computed tomography revealed subperiosteal temporal abscess extending intracranially. The pus was drained surgically via an otological and a neurosurgical approach, and pus sent for culture grew paecilomyces. He showed clinical improvement after receiving oral antifungal treatment postoperatively. Retrospectively, his occupation as an army officer and his diabetic immunocompromised state may have predisposed him to the infection. Results: Paecilomyces middle ear infection leading to intracranial involvement of such magnitude is yet to be reported, and we showcase its successful management through a combined surgical neuro-otology approach and oral antifungal therapy. Fungal ear infections can lead to severe extracranial and intracranial complications if inadequately treated. Differentiating it from cholesteatoma also presents a diagnostic challenge clinically and radiologically. While both can lead to intracranial complications, our patient's brief history and lack of prior ear symptoms contrast with that of cholesteatoma. Conclusion: The rarity of neuro-otological paecilomyces infections emphasizes the need for awareness and early identification. It is vital to recognize such infections, and prompt surgical management with appropriate antifungal drugs is warranted to prevent disastrous outcomes.https://www.advancedotology.org/en/beyond-the-ear-the-hidden-threat-of-paecilomyces-neuro-otological-infection-a-case-report-131971 |
| spellingShingle | Jing Hern Khoo Izny Hafiz Zainon Hafizah Husna Johari Ida Sadja’ah Sachlin Beyond the Ear, the Hidden Threat of Paecilomyces Neuro-Otological Infection: A Case Report Journal of International Advanced Otology |
| title | Beyond the Ear, the Hidden Threat of Paecilomyces Neuro-Otological Infection: A Case Report |
| title_full | Beyond the Ear, the Hidden Threat of Paecilomyces Neuro-Otological Infection: A Case Report |
| title_fullStr | Beyond the Ear, the Hidden Threat of Paecilomyces Neuro-Otological Infection: A Case Report |
| title_full_unstemmed | Beyond the Ear, the Hidden Threat of Paecilomyces Neuro-Otological Infection: A Case Report |
| title_short | Beyond the Ear, the Hidden Threat of Paecilomyces Neuro-Otological Infection: A Case Report |
| title_sort | beyond the ear the hidden threat of paecilomyces neuro otological infection a case report |
| url | https://www.advancedotology.org/en/beyond-the-ear-the-hidden-threat-of-paecilomyces-neuro-otological-infection-a-case-report-131971 |
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