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Aspergillus Fumigatus Otomastoiditis and Skull Base Osteomyelitis in a Patient With Advanced Acquired Immunodeficiency Syndrome

Psevdos, George Jr MD*†‡; Fefer, Jose MD*†‡; Patel, Vishal MD*; Srivastava, Swati MD§; Sharp, Victoria MD*‡

Infectious Diseases in Clinical Practice: May 2011 - Volume 19 - Issue 3 - pp 218-220
doi: 10.1097/IPC.0b013e3181f0c114
Case Reports

Although exposure to Aspergillus, a cosmopolitan and ubiquitous fungus in nature, is common, otomastoiditis is exceedingly rare. However, immunosuppression is a major predisposing factor for opportunistic Aspergillus infections. We report the case of a Hispanic man with acquired immunodeficiency syndrome and a low CD4+ T-cell count (21/mm3) who presented with Aspergillus otomastoiditis complicated by peripheral facial nerve palsy 2 weeks after initiation of antiretroviral therapy. The patient had complained of a left earache 3 weeks prior that resolved quickly with antibacterial therapy. Cases of Aspergillus ear infections in patients with acquired immunodeficiency syndrome before the advent of highly active antiretroviral therapy have been reported. As the patient's human immunodeficiency virus viral load became undetectable rapidly, it is possible that antiretroviral therapy could have exacerbated the infection leading to its final diagnosis.

From the *Department of Medicine, †Division of Infectious Diseases, ‡Center for Comprehensive Care, and §Department of Pathology, St Luke's Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY.

Correspondence to: George Psevdos Jr, MD, 1000 10th Ave Suite 2T, St Luke's Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY 10019. E-mail: gpsevdos@chpnet.org.

The authors have no funding or conflicts of interest to disclose.

© 2011 Lippincott Williams & Wilkins, Inc.