Abstract
A 65-year-old woman with a history of ear surgery during childhood was referred to our hospital. The patient had scleroderma and was receiving oral steroids (prednisolone 10mg/day). She developed left ear pain and otorrhea, which responded to pipercillin soudium and the symptoms disappeared. About 6 months later, she developed recurrent left ear pain and otorrhea accompanied by facial palsy. Ear swab culture demonstrated Pseudomonas aeruginosa resistant to all antibiotics except carbapenem. Computed tomography demonstrated bone destruction of the inner ear, middle and posterior fossa of the temporal bone. Magnetic resonance imaging showed that the diseased area extended to the apex of the pyramid. We performed exploratory tympanotomy to establish a diagnosis and it demonstrated cholesteatoma. Thereafter, we performed intravenous antibiotic administration and radical mastoidectomy. However, infection was not controlled, resulting in a spread to intracranial areas and the skull base. Unfortunately, the patient died after a clinical course lasting for one and a half years. This case was supposed to have involved osteomyelitis, as often seen in malignant otitis externa.
