Successful treatment of multi-drug resistant Pseudomonas aeruginosa, causing bilateral malignant otitis externa, media and mastoiditis

Background: Malignant external otitis (MEO) is a relatively uncommon infection caused by Pseudomonas aeruginosa seen primarily in immunocompromised patients, classically, diabetics. MEO is treated effectively with antibiotics but can be associated with significant morbidity including cranial nerve palsies. Objective: To report a case of MEO seen in a patient with myelodysplastic syndrome and prolonged neutropenia whose infection was resistant to all of the commonly used antibiotics, including fluoroquinolones, third generation cephalosporins, aminoglycosides, aztreonam, imipenem, and extended spectrum penicillins. Although there have been reports of ciprofloxacin resistant P. aeruginosa causing MEO infections, we were unable to locate any cases in the literature resistant to both ciprofloxacin and third generation cephalosporins. Method: To treat our patient’s MEO, we employed colistin, an antibiotic seldom used since the early 1980’s due to its nephrotoxicity. Results: The infection responded well to colistin, and with intermittent dosing, the patient did not suffer from deterioration of renal function and colistin resistance did not develop. Unfortunately, the case was also complicated by bilateral facial palsy and long-term bilateral hearing loss, two complications, which although common in this disease, are rarely seen in a bilateral fashion.

Cutaneous Curvularia infection in a neutropenic patient

Background: Cutaneous Curvularia is a rare fungal infection which presents itself as erythematous, non-tender, non-pruritic, ulcerative lesions. To the best of our knowledge, only a few cases reported in the literature have occurred in immunocompromised and/or neutropenic patients, none of which have been published within the past five years.Objective: We report the case of a 53-year-old man diagnosed with diffuse large B cell non-Hodgkin’s lymphoma and associated neutropenia who developed several erythematous macular lesions with central excoriations and crusting on his bilateral anterior tibiae, and whose fungal culture was positive for Curvularia sp.

Pseudomonas aeruginosa infections of cartilaginous structures

Background: Pseudomonas aeruginosa is a gram negative facultative anaerobe and well-documented scourge of immunocompromised patient populations. Objective: To study the prevalence and predisposing conditions for Pseudomonas aeruginosa infections of cartilaginous structures. Method and results: We conducted an exhaustive search of the current literature using PubMed, Ovid, and Google Scholar. The various clinical entities of pseudomonal chronditis are discussed with respect to their epidemiology, clinical manifestations, diagnosis, and treatment.

Surgical Maggots

Surgical maggots have been used successfully for wound debridement over the past millennium. At Johns Hopkins University in 1929, Baer introduced maggots into the wounds of 21 patients with chronic intractable osteomyelitis. The development of methicillin-resistant Staphlococcus aureus has been a major impetus to resurgent interest in maggot debridement. In January of 2004, the US Food and Drug Administration gave Dr. Ronald Sherman permission to produce and market surgical maggots for debriding non-healing necrotic skin and soft tissue wounds. Given an uncooperative patient with non-healing wounds, our medical team obtained insectary-reared sterile surgical maggots, Phaenicia sericata, to promote debridement of necrotic tissue and development of granulation tissue.