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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
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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

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