Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-28T12:20:45.806Z Has data issue: false hasContentIssue false
  • English
  • Français

Aspergillus petrous apicitis associated with cerebral and peritubular abscesses in an immunocompetent man

Published online by Cambridge University Press:  28 February 2013

Y M Bhatt ,
N Pahade  and
B Nair
Y M Bhatt*
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Royal Preston Hospital, UK
N Pahade
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Royal Preston Hospital, UK
B Nair
Affiliation:
Department of Pathology, Royal Preston Hospital, UK
*
Address for correspondence: Mr Y M Bhatt, Department of Otolaryngology Head and Neck Surgery, Royal Preston Hospital, Fulwood, Preston PR2 9HT, UK Fax: 01772 523233 E-mail: bhatt_ym@yahoo.co.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Petrous apex aspergillosis is an uncommon and dangerous condition, with only four previously reported cases. As with other forms of petrous apicitis, the clinical symptoms are often non-specific and this contributes to diagnostic delay. This paper presents the first reported case of Aspergillus petrous apicitis associated with an intracranial or nasopharyngeal abscess.

Case report:

A 72-year-old man with chronic otorrhoea developed neuralgic headaches and progressive lower cranial nerve palsies despite antibiotic therapy. Imaging revealed petrous apicitis, a temporal lobe abscess and nasopharyngeal abscess. Analysis of biopsy tissue indicated invasive aspergillosis. The patient recovered on a protracted course of voriconazole in addition to medium-term antibiotic therapy.

Conclusion:

Invasive fungal disease should be considered early in the course of skull base osteomyelitis that is clinically unresponsive to empirical broad spectrum antibiotics. This paper highlights the role of tissue biopsy in diagnosis, and the efficacy of voriconazole therapy without the need for radical surgery.

Keywords

AspergillosisNeuroaspergillosisPetrous BoneCranial Nerve DiseaseOtitis MediaMagnetic Resonance ImagingComplicationsPathologyEtiology
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 127 , Issue 4 , April 2013 , pp. 404 - 407
Copyright
Copyright © JLO (1984) Limited 2013

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Chole, RA, Donald, PJ. Petrous apicitis. Clinical considerations. Ann Otol Rhinol Laryngol 1983;92:544–51CrossRefGoogle ScholarPubMed
2Kountakis, SE, Kemper, JV Jr, Chang, CY, DiMaio, DJ, Stiernberg, CM. Osteomyelitis of the base of the skull secondary to Aspergillus. Am J Otolaryngol 1997;18:19–22CrossRefGoogle ScholarPubMed
3Scully, C, Paes de Almeida, O. Orofacial manifestations of the systemic mycoses. J Oral Pathol Med 1992;21:289–94CrossRefGoogle ScholarPubMed
4Denning, DW. Invasive aspergillosis. Clin Infect Dis 1998;26:781–805CrossRefGoogle ScholarPubMed
5Nivoix, Y, Velten, M, Letscher-Bru, V, Moghaddam, A, Natarajan-Amé, S, Fohrer, C et al. Factors associated with overall and attributable mortality in invasive aspergillosis. Clin Infect Dis 2008;47:1176–84CrossRefGoogle ScholarPubMed
6van Tol, A, van Rijswijk, J. Aspergillus mastoiditis, presenting with unexplained progressive otalgia, in an immunocompetent (older) patient. Eur Arch Otorhinolaryngol 2009;266:1655–7CrossRefGoogle Scholar
7Eloy, JA, Bederson, JB, Smouha, EE. Petrous apex aspergillosis as a long-term complication of cholesterol granuloma. Laryngoscope 2007;117:1199–201CrossRefGoogle ScholarPubMed
8Ederies, A, Chen, J, Aviv, RI, Pirouzmand, F, Bilbao, JM, Thompson, AL et al. Aspergillosis of the petrous apex and Meckel's cave. Skull Base 2010;20:189–92CrossRefGoogle ScholarPubMed
9Lee, YH, Lee, NJ, Kim, JH, Song, JJ. CT, MRI and gallium SPECT in the diagnosis and treatment of petrous apicitis presenting as multiple cranial neuropathies. Br J Radiol 2005;78:948–51CrossRefGoogle ScholarPubMed
10Clark, MP, Pretorius, PM, Byren, I, Milford, CA. Central or atypical skull base osteomyelitis: diagnosis and treatment. Skull Base 2009;19:247–54CrossRefGoogle ScholarPubMed
11Blyth, CC, Gomes, L, Sorrell, TC, da Cruz, M, Sud, A, Chen, SC. Skull-base osteomyelitis: fungal vs. bacterial infection. Clin Microbiol Infect 2011;17:306–11CrossRefGoogle ScholarPubMed
12Shamim, MS, Siddiqui, AA, Enam, SA, Shah, AA, Jooma, R, Anwar, S. Craniocerebral aspergillosis in immunocompetent hosts: surgical perspective. Neurol India 2007;55:274–81Google ScholarPubMed
13Srinivasan, US. Intracranial aspergilloma in immunocompetent patients successfully treated with radical surgical intervention and antifungal therapy: case series. Ann Acad Med Singapore 2008;37:783–7CrossRefGoogle ScholarPubMed
14Herbrecht, R, Denning, DW, Patterson, TF, Bennett, JE, Greene, RE, Oestmann, JW et al. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 2002;347:408–15CrossRefGoogle ScholarPubMed
15Walsh, TJ, Anaissie, EJ, Denning, DW, Herbrecht, R, Kontoyiannis, DP, Marr, KA et al. Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis 2008;46:327–60CrossRefGoogle ScholarPubMed
16Amonoo-Kuofi, K, Tostevin, P, Knight, JR. Aspergillus mastoiditis in a patient with systemic lupus erythematosus: a case report. Skull Base 2005;15:109–12CrossRefGoogle Scholar
17Denning, DW, Ribaud, P, Milpied, N, Caillot, D, Herbrecht, R, Thiel, E et al. Efficacy and safety of voriconazole in the treatment of acute invasive aspergillosis. Clin Infect Dis 2002;34:563–71CrossRefGoogle ScholarPubMed
18Boyd, AE, Modi, S, Howard, SJ, Moore, CB, Keevil, BG, Denning, DW. Adverse reactions to voriconazole. Clin Infect Dis 2004;39:1241–4CrossRefGoogle ScholarPubMed
19Parize, P, Chandesris, MO, Lanternier, F, Poirée, S, Viard, JP, Bienvenu, B et al. Antifungal therapy of Aspergillus invasive otitis externa: efficacy of voriconazole and review. Antimicrob Agents Chemother 2009;53:1048–53CrossRefGoogle ScholarPubMed
20Hiraga, A, Uzawa, A, Shibuya, M, Numata, T, Sunami, S, Kamitsukasa, I. Neuroaspergillosis in an immunocompetent patient successfully treated with voriconazole and a corticosteroid. Intern Med 2009;48:1225–9CrossRefGoogle Scholar
21Parsonage, MJ, Stafford, ND, Lillie, P, Moss, PJ, Barlow, G, Thaker, H. Oral voriconazole for invasive fungal skull base infection. J Laryngol Otol 2010;124:1010–13CrossRefGoogle ScholarPubMed