Fungal Skull Base Osteomyelitis Caused By Stephanoascus Ciferrii

Abstract

Background: Necrotising otitis externa is a rapidly progressing, locally invasive infection of the external auditory canal. Also known as skull base osteomyelitis, this potentially fatal condition is almost exclusively seen in immunocompromised patients, especially in elderly diabetic patients. Most of the cases are bacterial in origin, Pseudomonas being the most common causative agent. Fungal aetiology is very rare but carries a worse prognosis compared to bacterial infection, possibly due to a delay in diagnosis and due to the dose limiting adverse effects of most of the systemic anti-fungal agents. Case Presentation: We present a 67 year old diabetic patient with right fungal necrotising otitis externa, caused by Stephanoascus ciferii, a very rare but emerging fungal pathogen. The patient was successfully treated and cured with systemic voriconazole. Conclusion: This case report highlights the importance of considering the possibility of fungal aetiology in all cases of clinically suspected necrotising otitis externa, where the ear swab culture doesn't yield a proper bacterial growth. A fungal culture and sensitivity study is recommended in all such cases. In the rare event of both cultures becoming negative, voriconazole can be used as a safe empirical agent along with empirical antipseudomonal drugs. [Amjad F SEAJCRR 2018; 7(4):33-38]