Multicentric Case Series and Literature Review of Coccidioidal Otomastoiditis

Abstract

Coccidioidomycosis involving the ear, mastoid bone, or both is uncommon. We describe 5 new cases from the United States and review 4 cases reported in the literature of otomycosis and mastoiditis caused by Coccidioides. Of the 9 cases, 8 were linked to residence in or travel to California. Two patients had poorly controlled diabetes mellitus, 7 had otomastoiditis, 1 had otitis externa without mastoid involvement, and 1 had mastoiditis without otic involvement. Four patients had concurrent or prior pulmonary coccidioidomycosis. Ipsilateral facial nerve palsies developed in 2 patients. All patients received antifungal treatment for varying durations, and 8 of the 9 patients underwent surgical debridement. Clinicians should consider coccidioidomycosis as a differential diagnosis for otomastoiditis in patients with geographic risks.

Keywords: Canada; United States; coccidioidal otomastoiditis; coccidioidomycosis; fungal; fungi; lung diseases; otomycosis; respiratory infections.

Figure 1

Radiographic findings from 22-year-old Hispanic man from California, USA (case 4), in multicentric case series of coccidioidal otomastoiditis. A) Computed tomography scan of the head, showing opacification of the mastoid. B) Magnetic resonance image of brain, showing mastoiditis.

Figure 2

Radiographic findings from 25-year-old Hispanic man from New Mexico, USA (case 5), in multicentric case series of coccidioidal otomastoiditis. A) Computed tomography scan of the chest with contrast, showing septic emboli of the left lower lung lobe and lingula with developing pneumonia. B) Magnetic resonance venogram, showing stable thrombus of the right jugular bulb, right sigmoid and transverse sinuses, and partially occlusive thrombus in the anterior superior sagittal sinus, seen by lack of enhancement (arrows) compared with the left side.