Aspergillus Mastoiditis in a Patient with Systemic Lupus Erythematosus: A Case Report

ABSTRACT

Fungal mastoiditis caused by Aspergillus fumigatus predominantly occurs in immunocompromised patients. Invasive temporal bone mycoses are rare. They are usually associated with host immunodeficiency, are difficult to diagnose, and many cases are fatal. Treatment consists of antifungal chemotherapy, surgical debridement, and attempts to control the underlying immunological condition. Published reports describe patients with previous ear pathology and associated facial nerve dysfunction. We report a case in a patient with systemic lupus erythematosus. A good outcome followed surgical debridement and the use of a new triazole antifungal agent, voriconazole. Our patient’s facial nerve function was unaffected. The presence of normal facial nerve function, however, does not exclude the possibility of invasive fungal mastoiditis.

KEYWORDS

Ear - temporal bone - mastoid - fungal infection - immunosuppression - mycoses

REFERENCES

• 1 Adams Jr N F. Infections involving the ethmoid, maxillary and sphenoid sinus and the orbit due to Aspergillus fumigatus .  Arch Surg. 1923;  26 999-1009
• 2 Petrak R M, Pottage J C, Levin S. Invasive external otitis caused by Aspergillus fumigatus in an immunocompromised patient.  J Infect Dis. 1985;  151 196
• 3 Hall P J, Farrior J B. Aspergillus mastoiditis.  Otolaryngol Head Neck Surg. 1993;  108 167-170
• 4 Teh W, Matti B S, Marisiddaiah H, Minamoto G Y. Aspergillus sinusitis in patients with AIDS: report of three cases and review.  Clin Infect Dis. 1995;  21 529-535
• 5 Cunningham M, Yu V L, Turner J, Curtin H. Necrotizing otitis externa due to Aspergillus in an immunocompetent patient.  Arch Otolaryngol Head Neck Surg. 1988;  114 554-556
• 6 Bryce G E, Phillips P, Lepawsky M, Gribble M J. Invasive Aspergillus tympanomastoiditis in an immunocompetent patient.  J Otolaryngol. 1997;  26 266-269
• 7 Hora J F. Primary aspergillosis of the paranasal sinuses and associated areas.  Laryngoscope. 1965;  75 768-773
• 8 McGill T J. Mycotic infection of the temporal bone.  Arch Otolaryngol. 1978;  104 140-144
• 9 Stanley R J, McCaffrey T V, Weiland L H. Fungal mastoiditis in the immunocompromised host.  Arch Otolaryngol Head Neck Surg. 1988;  114 198-199
• 10 Slack C, Watson D W, Abzug M J, Shaw C, Chan K H. Fungal mastoiditis in immunocompromised children.  Arch Otolaryngol Head Neck Surg. 1999;  125 73-75
• 11 Denning D W, Tucker R M, Hanson L H, Stevens D A. Treatment of invasive Aspergillus with itraconazole.  Am J Med. 1989;  86 791-800
• 12 Patterson T F. Role of newer azoles in surgical patients.  J Chemother. 1999;  11 504-512
• 13 Sheehan D J, Hitchcock C A, Sibley C M. Current and emerging azole antifungal agents.  Clin Microbiol Rev. 1999;  12 40-79
• 14 Ruhnke M. Voriconazole-application and perspectives.  Mycoses. 2002;  45 42-47
• 15 Johnson L B, Kaufmann C A. Voriconazole: a new triazole antifungal agent.  Clin Infect Dis. 2003;  36 630-637
• 16 Ullmann A J. Review of the safety, tolerability and drug interactions of the new antifungal agents caspofungin and voriconazole.  Curr Med Res Opin. 2003;  19 263-271
• 17 Hoffman H L, Rathbun R C. Review of the safety and efficacy of voriconazole.  Expert Opin Investig Drug. 2002;  11 409-429