A neutropenic acute myeloid leukemia patient complicated with chronic otitis media due to Aspergillus niger and yeast-like fungi caused by superinfection

Abstract

There have been few reports describing otomycosis in association with compromised hosts. So we report a neutropenic acute myeloid leukemia (AML) patient complicated with otomycosis caused by superinfection. A 51-year-old male was admitted because a third relapse of AML in March 1998. Two years ago, he was diagnosed as having chronic otitis media involving the VII cranial nerve due to Pseudomonas aeruginosa coinciding with AML. Then, he had suffered from a right-sided earache and otic discharge in accord with every myelosuppression, which improved on treatment with otic administration of ofloxacin. After 1 course of induction chemotherapy, he developed a spiking fever with severe earache and otic discharge at a nadir period of WBC. Ear swab cultures yielded Aspergillus niger and yeast-like fungi. So, he was treated with intravenous administration of amphotericin B (AMPH-B): initial dose was 5 mg/day and was gradually increased to 30 mg/day. Thereafter, the otic symptoms subsided and never recurred. Subsequently, he was given another antifungal agent, itraconazole. Although induction chemotherapies resulted in failure, he did not suffer otic symptoms until his death due to cerebral bleeding in January 1999. For neutropenic patients without rapid hematological improvement, we recommend intensive antifungal therapy as the first-line of therapy for otomycosis rather than local therapy.