Bilateral Otitis Media and Mastoiditis Caused by a Highly Resistant Strain of Mycobacterium chelonae

Bilateral acute mastoiditis and subperiosteal abscesses in a child managed by simultaneous bilateral mastoid surgery

“…In one case, there was a delay of one day between surgery on each side, while in another there was a delay of two and a half months. 6,7 Interestingly, in the only other published case of bilateral acute mastoiditis and bilateral subperiosteal abscesses, Oyarzabal et al 3 performed simultaneous bilateral cortical mastoidectomy, bilateral abscess drainage with insertion of mastoid drains, and bilateral insertion of ventilation tubes, similar to our case. In our case, the patient's middle ear was open and discharging yet he did not improve on intravenous antibiotics.…”

“…5,6 Bilateral mastoiditis as a result of mycobacterial infection has also been reported, which presents a particular challenge to treat. 7,8 In addition, there have been cases of bilateral 'masked' mastoiditis following multiple antibiotic therapy, presenting with bilateral facial nerve palsy. 9,10 It is therefore possible that bilateral mastoid involvement is much more common than previously thought, but that antibiotics control the disease and it remains subclinical.…”

Nontuberculous mycobacterial osteomyelitis

“…Many slow-growing NTM species have demonstrated the ability to cause NTM osteomyelitis, including M. avium-intracellulare complex (MAC) [ 3 , 8–48 ], M. ulcerans [ 49–51 ], M. marinum [ 52–57 ], M. kansasii [ 9 , 33 , 36 , 58–63 ], M. xenopi [ 64–66 ], M. gordonae [ 67 ], M. haemophilium [ 33 , 68 , 69 ], M. scrofulaceum [ 45 , 70 ], M. szulgai [ 71–74 ], M. longobardum [ 75 ], and M. flavescens [ 76 ]. Among the rapidly growing mycobacteria, osteomyelitis can be caused by M. abscessus [ 3 , 77–81 ], M. fortuitum [ 82–94 ], M. chelonae [ 5 , 25 , 83 , 95–104 ], M. smegmatis [ 105 ], M. peregrinum [ 82 ], and M. thermoresistibile [ 106 ]. Some authors have argued that the otomastoiditis attributed to M. fortuitum or M. chelonae was actually caused by M. abscessus [ 107 ], though this disagreement is actually a taxonomic issue.…”

Mycobacterium abscessus, an Uncommon Cause of Chronic Otitis Media

“…The majority of human NTM infections are caused by these environmental mycobacteria. 6,7,9 Runyon 4 first described these mycobacteria as human pathogens in the 1950s and classified them in 4 groups based on growth rate and pigment production. In our case, the infection was caused by M abscessus, belonging to the group of rapid-growing NTM (visible colony formation within 7 days of subculture).…”

“…1,6-8 Postoperative wound healing problems and dischargearerelativelycommon,even under antibiotic treatment. [7][8][9]12 Treatment should consist of removal of all foreign bodies and a combination of extensive surgical debridement and long-term therapy with multiple antibiotics. Spontaneous recovery is rare.…”