Scedosporium apiospermum Otitis Complicated by a Temporomandibular Arthritis: A Case Report and Mini-Review

Abstract

Scedosporium apiospermum is an ubiquitous fungus responsible for various infections in immunocompromised and immunocompetent patients. Ear infections are infrequent. We report an exceptional case of S. apiospermum external otitis complicated by temporomandibular joint arthritis. After 6 months of antibiotherapy, diagnosis was established by mycological analysis of external auditory canal and infratemporal fossae needle sampling. A satisfactory outcome was obtained after 2 months of voriconazole alone. We have reviewed 15 cases of S. apiospermum otitis. Seven of these patients were immunocompromised. Most common clinical presentation included a chronic external otitis lasting months or years before complication stage. Most common clinical features included recurrent unilateral otalgia (11/15) and purulent otorrhea (13/15). Diagnosis was often made at later stage (12/15) with local extension to bones and/or soft tissues (9/15) or cerebral lethal dissemination (3/15).The extremely low incidence of S. apiospermum otomycosis and its non-specific presentation results in a frequent diagnosis delay. A mycological investigation should be performed in case of persistent external otitis and/or osteolysis despite prolonged antibiotic treatment to prevent further extension of the disease.

Scedosporium apiospermum: a rare cause of malignant otitis externa

“…Previous published cases of MOE have involved patients suffering from HIV 4. Excluding MOE, S. apiospermum has been isolated as a cause of otitis externa in other case reports and case series;5–8 one case of otitis externa was treated solely with Voriconazole after 6 months of failed antibiotic therapy5 similar to this case; however, there was no evidence of MOE.…”

“…It would be wrong to ascertain from this case that all patients with a diagnosis of MOE should take antifungal medication and antibiotics; however, this case suggests that it should always be a consideration in individuals not responding to broad-spectrum intravenous antibiotic administration that the causative pathogen could be fungal. Tissue sampling has been shown to be effective in isolating pathogens when initial pus swabs have been sterile;2 as was the case with this individual, the causative pathogen was identified via extended culture of sequestered bone from the external auditory canal, and this has also been the situation in refractory cases of otitis externa 5…”

Scedosporium apiospermum infectious scleritis following posterior subtenon triamcinolone acetonide injection: a case report and literature review

“…Scedosporium apiospermum is one of hyaline filamentous fungi that are ubiquitously present in soil, sewage and polluted water [ 25 ]. While it was previously considered to be the asexual state of Pseudallescheria boydii , it has now been shown to be two distinct species [ 27 – 29 ]. Presently, Scedosporium apiospermum is considered to be a species complex that is comprised of Scedosporium apiospermum sensu stricto, Scedosporium boydii , Scedosporium dehoogii , Scedosporium aurantiacum and Scedosporium minutisporum [ 27 ].…”

“…While it was previously considered to be the asexual state of Pseudallescheria boydii , it has now been shown to be two distinct species [ 27 – 29 ]. Presently, Scedosporium apiospermum is considered to be a species complex that is comprised of Scedosporium apiospermum sensu stricto, Scedosporium boydii , Scedosporium dehoogii , Scedosporium aurantiacum and Scedosporium minutisporum [ 27 ]. The fungal isolate in the current study was definitively identified as Scedosporium apiospermum sensu stricto through the use of DNA sequencing of the β-tubulin gene, which is currently the most reliable identification method for this genus [ 29 , 30 ].…”

Multi-organ involvement caused by Scedosporium apiospermum infection after near drowning: a case report and literature review

“…Secondly, although local and systemic voriconazole treatment started after admission to our hospital, the intravitreal injection was not performed, hence the optimal intraocular penetration concentration failed to achieve, or the vitreous body was not removed in time led to the poor prognosis. In a review of 15 cases associated with S. apiospermum infection, treatments with amphotericin B and ketoconazole were associated with poor prognosis, whereas voriconazole and itraconazole were associated with better prognosis [ 10 ]. In the cases we listed, voriconazole was used in nine cases, including our case, which resulted in two deaths (22%) and an improvement of seven cases (78%).…”