Un cas d'otite externe compliquee (Tune osteolyse due a Scedosporium apiospermum A case report of an otitis externa with osteolysis caused by Scedosporium apiospermum

摘要

Summary Scedosporium apiospermum (S. apiospermum) otitis led to an osteolysis of the petrous bone in a 72-year-old non-insulinodependant diabetic patient. He was suffering from otorrhoea for more than six months. A malignant otitis externa was diagnosed despite the lack of pain and the rapid evolution of the lesions. S. apiospermum (Pseudallescheria boydii), a telluric fungus, was isolated from the external auditory canal. Since this fungus is known to be a saprophyte, ceftazidim and ciprofloxacin as a probabilistic antibiotherapy was initiated. The treatment was changed for oral voriconazole (minimal inhibitory concentration: 0.G02 (ig/ml) while the same fungus was isolated twice. Osteolytic otitis externa caused by S. apiospermum diagnosis was confirmed by the repetitive isolation of the fungus in culture and pathological features. Otitis caused by Scedosporium is rare and therapeutic consensus is lacking. Similar osteolysis located at other localizations have mainly been treated by voriconazole and surgical debridation. In spite of its very low frequency, this aetiology of otitis is worrying, because diagnostic delay, hence therapeutic delay, might lead to complications. When fungus from environment is isolated, mycological data from cultures should be analysed in agreement with tissue samples microscopic examination in order to use efficient antifungal therapy. Attention should be focused on few telluric fungus (eg S. apiospermum) needing a repetitive sampling.