Necrotizing external otitis in a patient caused by Klebsiella pneumoniae

Otology

DOI: 10.1007/s00405-005-0998-y

Cite this article as:
Yang, TH., Kuo, ST. & Young, YH. Eur Arch Otorhinolaryngol (2006) 263: 344. doi:10.1007/s00405-005-0998-y

Abstract

Necrotizing external otitis is a potentially life-threatening infection involving the temporal and adjacent bones. The most frequent pathogen is attributed to Pseudomonas aeruginosa, but is rarely caused by Klebsiella pneumoniae. Recently, we encountered a 47-year-old diabetic man with a swollen obliterated external ear canal with granulation tissue on the right ear. Image study demonstrated skull base osteomyelitis, epidural abscess and cerebral venous sinus thrombi. It was later proved to be necrotizing external otitis caused by Klebsiella pneumoniae. He then underwent craniotomy for drainage of the epidural abscess, followed by intravenous ciprofloxacin and metronidazole for 2 consecutive weeks until both pus and blood cultures depicted no growth of pathogens. Based on this case, synergistic antibiotic therapy using a third-generation cephalosporin or quinolone (ciprofloxacin), accompanied by metronidazole, and even a short-term aminoglycoside is recommended for the treatment of severe Klebsiella-induced necrotizing external otitis. Surgical intervention should be limited without shedding of the pathogens.

Keywords

Necrotizing external otitis Klebsiella pneumoniae Cerebral venous sinus thrombosis 

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  1. 1.Department of OtolaryngologyNational Taiwan University Hospital and College of MedicineTaipeiTaiwan

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