Fig 5
Soft tissue density in the middle ear cavity and mastoid air cells, neither violating the scutum (black arrow) nor violating the ossicles (*).
Source publication
Skull base osteomyelitis (SBO) also commonly known as malignant otitis externa was first described by Meltzer and Kelemen in 1959. Prior to the advent of the antibiotic era, this disease carried a poor prognosis with significant morbidity. It often proved fatal with mortality rates as high as 50%. Commonly seen in the immunocompromised patients, di...
Context in source publication
Context 1
... stylomastoid foramen and adjacent stylomastoid process showed inflammation ( Figure 4). The right middle ear cavity and mastoid air cells were filled with soft tissue densities, however there was no destruction of the ossicles or the scutum ( Figure 5). After 2 weeks of medical therapy using antimicrobials, there was marked resolution in otalgia, and he was able to sleep well at night. ...
Citations
... 4 Commonly seen in immunocompromised patients, diabetes mellitus is an important associated comorbidity in the pathophysiologic development of this disease. 30 Noncognizance of diabetes mellitus can be devastating for the maxillofacial region and may be fatal for the patient. 22 In another case, diabetes mellitus is able to trigger the exacerbation of osteomyelitis. ...
The hallmark of osteomyelitis was progressive bone destruction and sequestrum formation. In the underlying disease, like diabetes mellitus, osteomyelitis becomes severe and exacerbates the condition. It was essential for the oral and maxillofacial surgeon to comprehend its complex medical and surgical management to achieve complete disease eradication. The aim of this article was to report a rare case and comprehensive management of extensive sequestrating maxillary osteomyelitis with uncontrolled diabetes mellitus patients. A 58-year-old male patient with pain and swelling accompanied by discharge of pus in the sinistra maxilla region. The systemic disease was identified as uncontrolled diabetes mellitus, and had a history of unhealing wounds 1 year ago after upper left molar extraction. Computed tomography scan result showed extensive sequester formation and bony destruction in the right extending to the left maxilla. Microbial culture results were Klebsiella pneumoniae and Morganella morganii. Subsequently, extensive sequestrectomy and multiple extractions of the involved jaw and teeth were performed after diabetes mellitus was regulated. A suspension suture against oral and nasal mucosa was performed to avoid dead space formation. Comprehensive perioperative management in maxillary osteomyelitis in uncontrolled diabetes mellitus includes sequestrectomy, definitive antibiotic therapy based on culture results, and diabetes regulation to improve the successful management of this case.
... Its etiology mainly includes bloodstream infection, traumatic infection, blood circulation disorder, and low host immune function. Almost all microorganisms, including viruses, bacteria, and fungi, can cause osteomyelitis. 1 Many pathogens such as Staphylococcus aureus, 2 Salmonella, 3 Candida, 4 non-tuberculous mycobacteria (NTM), 5 Cryptococcus, 6 Bartonella, 7 and Mycobacterium tuberculosis 8 have been reported to cause osteomyelitis. NTM have recently garnered increased research attention because they can cause infections in immunocompromised patients, in whom, the infection presents as a disseminated extrapulmonary form. ...
Purpose
To report a rare case of tibial osteomyelitis caused by Mycobacterium aubagnense and its L-form, to systematically review non-tuberculous mycobacteria (NTM) infections of the bones, and to summarize the medication guidelines for infections with NTM and its L-forms.
Methods
Case report and literature review.
Results
We report a 31-year-old HIV-positive man who developed osteomyelitis caused by M. aubagnense and its L-form. Culture, electron microscopy, polymerase chain reaction assay, and a reversion test confirmed the existence of M. aubagnense. The patient was treated with surgical debridement and a combination of systemic antibiotics, and continued to take antiretroviral treatment. Some clinical improvement was noted shortly after the initiation of this treatment. Resolution of osteomyelitis was achieved after 10 months. We also systematically reviewed cases of NTM osteomyelitis in the PubMed database and compared antibiotic sensitivity between L-forms and their prototype bacteria. We have summarized the treatment regimens for infections of the bone and bone marrow caused by NTM and their L-forms.
Conclusion
We have reported the first case of refractory osteomyelitis caused by M. aubagnense and its L-form in a patient with immune deficiency, reviewed the literature on NTM osteomyelitis, and compared the antibiotic sensitivity of L-forms and their prototype bacteria.
... Interestingly, although the incidence of diabetes mellitus was comparable in patients with bacterial and fungal pathology, neurological complications were more frequent with the latter (14 % vs 55 %). Searching the literature for similar published case reports of fungal SBO in adults, yielded 9 cases, 6 of which were reported in English (Table1; (10)(11)(12)(13)(14)(15)). Reported isolated pathogens are two of each; Candida albicans, Candida parapsilosis and Candida glabrata. ...
Background
Malignant otitis externa (MOE) is a serious infection of the external auditory canal that is frequently associated with skull base osteomyelitis (SBO) as well as secondary neurological sequelae. Patients with poorly controlled diabetes mellitus or immunosuppression are at increased risk of developing such critical infection for multiple local and systemic factors. While most cases are secondary to bacterial infections particularlyPseudomonas aeruginosa, fungal infections are also occasionally encountered, often associated with delayed diagnosis and high morbidity and mortality.
Case report
We report a case of a 63 years old man with uncontrolled diabetes mellitus who presented with symptoms and signs of MOE, supported by radiological assessments. The patient was treated presumptively with a prolonged course of antibiotics without clinical improvement, coupled with progression of radiological findings and significant disease extension. Reassessment with biopsies and tissue cultures from external auditory meatus, tempo-mandibular bone, as well as base of the skull grew Candida orthopsilosis. The patient received induction treatment with high dose liposomal amphotericin followed by fluconazole to control disease progression and complications.
Conclusion
Candida MOE with secondary skull base osteomyelitis is rare and difficult to diagnose with no clear guidance on assessment and management. Clinicians should be aware of the unusual presentations where microbiological and histopathological evaluations are essential for proper management.
