Asia Pacific Journal of Pediatric and Child Health

Abstract Ref Number = APCP948

Poster Presentation

MALIGNANT OTITIS EXTERNA (SKULL BASE OSTEOMYELITIS) IN AN INFANT

Amar WAdisasmito,Dwinanda A Fitrani,Abdillah Hasbi Pediatric Infectious and Tropical Disease Division Department of Pediatrics Harapan Kita Women and Children Hospital Jakarta Indonesia Pediatric Infectious and Tropical Disease Division Department of Pediatrics, Harapan Kita Women and Children Hospital Jakarta Indonesia Department of ENT, Harapan Kita Women and Children Hospital Jakarta Indonesia

Background : Malignant otitis externa associated with skull base osteomyelitis involving adjacent bones, is a rare but life-threatening condition. This is uncommon under 2 years old. It occurs primarily in immunocompromised patients. Treatment includes local treatment of the auditory canal and abscess drainage, 3-6 weeks systemic antibiotic therapy, and surgery in selected patients. Predictors of an adverse outcome include skull base osteomyelitis, intracranial extension and multiple cranial nerve involvement. Case Presentation Summary : We report a case of malignant left otitis externa with blood drained in 4-month-old boy, presented with 8-days fever. There were multiple sellulitis on lower lip, left parotis and right hands, affected by Pseudomonas. Marked edema on extremities and ascites due to hypoalbuminemia, were found. The infection spread to temporal bone causing osteomyelitis, shown on temporal bone CT, then extended into cranium and resulted in left facial nerve palsy (Bell’s palsy). Brain MSCT revealed no meningitis nor bone destruction. There was clinical sepsis accompanied by systemic pseudomonal infection. He had petechiae with increased PT and APTT, also anemia due to severe infection which was treated with PRC transfusion. Irritant decubitus near anal and UTI also occurred by some episodes of diarrhea. No proof of immunodeficiency, tuberculosis nor HIV infection. Immunophenotyping of bone marrow did not reveal any malignancy. Echocardiography showed normal coronary artery. Debridement was done with parotis abscess drained. He was treated with intravenous ampicillin-sulbactam but no clinical improvement, then changed to 21 days intravenous meropenem with which he recovered completely. Learning Points/Discussion : Careful diagnostic procedures and treatment are related to better prognosis. This case is severe possibly because of immature immunity in very young infant. Risk factors of this case is still unknown.

Keywords: malignant otitis externa osteomyelitis infant