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

• Published in: Journal of laryngology and otology Vol. 127; no. 4; pp. 404 - 407
• Main Authors: Bhatt, Y M, Pahade, N, Nair, B
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.04.2013
• Subjects: 14-alpha Demethylase Inhibitors; Abscess - complications; Abscess - diagnosis; Abscess - drug therapy; Abscesses; Aged; Antibiotics; Antifungal Agents - therapeutic use; Aspergillus; Biopsy; Clinical Records; Cranial Nerve Diseases - diagnostic imaging; Cranial Nerve Diseases - pathology; Delayed Diagnosis; Ear diseases; Humans; Immunocompetence; Infections; Magnetic Resonance Imaging; Male; Neuroaspergillosis; Neurological disorders; Petrositis - complications; Petrositis - diagnosis; Petrositis - drug therapy; Pyrimidines - therapeutic use; Radiography; Skull Base - diagnostic imaging; Tomography; Triazoles - therapeutic use; Voriconazole; Petrous Bone; Magnetic Resonance Imaging; Pathology; Complications; Etiology; Aspergillosis; Cranial Nerve Disease; Otitis Media; Neuroaspergillosis
• ISSN: 0022-2151; 1748-5460
• DOI: 10.1017/S0022215113000315

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. 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. 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.