Histoplasma tympanomastoiditis: Case report and literature review

Abstract

Histoplasma is a dimorphic fungus capable of producing a diverse array of clinical pathology in humans dependent upon the host immune status. Acute symptomatic infection typically presents as an isolated pulmonary or nodal disease in immunocompetent patients with extra-thoracic manifestations rarely seen in this population. In this report, we describe a novel case of Histoplasma capsulatum tympanomastoiditis in an immunocompetent patient who presented with progressively worsening purulent otorrhea, vertigo, and facial nerve palsy. He was successfully managed with surgical debridement and a prolonged antifungal course.

Keywords: Fungal otomastoiditis; Histoplasmosis.

Fig. 1

T1 fast spin echo brain magnetic resonance imaging showing soft tissue or fluid density material within the left middle ear cavity and left mastoid air cells as well as bony demineralization of the ossicular chain (as denoted by the white arrow).

Fig. 2

Small, ovoid, narrow-based budding yeast imbedded within either monocytes or macrophages (as depicted by the arrows in Fig. 2A and on Fig. 2B).

Fig. 3

Potato dextrose agar showing growth of Histoplasma capsulatum after several weeks. Characteristic white cotton-like colonies can readily be seen (Fig. 3A). With the passage of time, transitions in color can occur from a whitish appearance (Fig. 3B) to a gray to brownish appearance (Fig. 3C).