Francesco Ciodaro, Sergio De Luca, Francesco Gazia, Francesco Freni, Bruno Galletti
Malignant otitis externa (MOE) also known as skull base osteomyelitis or necrotizing otitis externa, is a rare inflammatory and infectious condition mainly caused by Pseudomonas Aeruginosa, mainly affects elderly, diabetic and immunocompromised patients. Due to the rapidity of development, it is associated with a high rate of motility/morbidity. In this case report, we describe a rare neurological presentation in a 58-year-old male patient, diabetic, who presented with onset of right otitis externa associated with otalgia, otorrhea, and ipsilateral headache. The auricular swab was positive for Pseudomonas Aeruginosa, the necrotizing inflammation evolved rapidly with progressive clinical involvement of right cranial nerves VII, V, X (Right recurrent laryngeal nerve), III, IV, VI. The role of imaging was to confirm the initial oto-mastoid involvement and to specify the extent of the lesion. CT-scan assessed bone involvement and the MRI delineated the extent of the inflammatory pathology. During the first months of his recovery, the patient contracted SARS-COV-2 infection, which induced a clinical and radiological worsening of the initial pattern in relation to the hypoxemic states achieved in the course of interstitial pneumonia. Finally the patient was treated with Meropenem 1 g ev per day. At the end of treatment, the patient presents almost complete resolution of pathology on both clinical and radiological bases. The aim of this manuscript is to report the management and treatment of a rare case of MOE co-infected with SARS-COV-2.