Intravenous amphotericin B was promptly administered postoperatively. The biopsy specimen revealed characteristic branching septate hyphae ( Fig 3), and the final pathologic diagnosis was aspergillosis involving the IAC and the inner ear. Meticulous debridement of the lesion in the IAC and the inner ear was performed. A frozen biopsy specimen from the supralabyrinthine air cells and the IAC showed multiple fungal hyphae in the necrotic neural tissue debris. The patient underwent open biopsy via translabyrinthine approach. On the basis of medical history, physical examination, CSF study, and various imaging studies, the possible differential diagnoses of this lesion included chronic nonbacterial infection, low-grade malignancy, and pseudotumor. Neither microorganisms nor malignant cells were identified in the CSF analysis, which was performed 15 days after follow-up MR imaging. However, PET/CT did not reveal any abnormal fluorodeoxyglucose (FDG) uptake in the left inner ear or IAC. To rule out the possibility of malignancy, we performed positron- emission tomography superimposed on CT (PET/CT). Enhanced T1-weighted images showed diffuse enhancement of the lesion in the IAC. The left IAC was also filled with abnormal hypointense signal intensity suggesting a mass lesion. T2-weighted MR images revealed some areas of low signal intensity involving the left cochlea and vestibule, replacing the normal high signal intensity of CSF ( Fig 1). We reviewed the MR images from the other hospital, which had been obtained immediately after the development of facial paralysis. Pure-tone audiometry showed profound sensorineural hearing loss involving the left ear. Vital signs were normal, and comprehensive laboratory data, including blood sampling and chest radiographic findings, were unremarkable. Otoscopic examination showed a postoperative tympanic membrane without any evidence of active inflammation. Physical examination of the patient revealed marked left facial weakness, even in the resting state, which was consistent with complete facial paralysis. He was referred to our institution for further evaluation 3 months after development of facial nerve palsy. Headache, left-sided hearing loss, and facial nerve palsy gradually progressed despite steroid therapy. Left facial nerve palsy was detected 6 months after the surgery. He had undergone intact canal wall mastoidectomy and tympanoplasty for control of left chronic otitis media at another hospital about 9 months before the visit to our department. We present a case of aspergillosis involving the inner ear and the internal auditory canal (IAC) following ear surgery.Ī 61-year-old man visited our department for evaluation of left facial palsy and progressive hearing loss. 3 Early detection and proper diagnosis are crucial in the treatment of CNS aspergillosis. 3 In immunocompromised patients, the mortality rate is much higher, nearly 99%. 1 Although there have been some cases with successful treatment with amphotericin B, 2 the reported response rate of CNS aspergillosis to amphotericin B is only 33% in patients with normal immunity. The presence of rim enhancement of the vestibulocochlear nerve, abnormal signal intensity involving the labyrinth, and adjacent meningeal enhancement might help clinicians to make a correct diagnosis in patients with a mass in the IAC and previous history of ear surgery.Īspergillosis of the central nervous system (CNS) is a rare condition that usually involves the CNS in immunocompromised hosts, but intracranial aspergillosis has been also reported in immunocompetent patients. SUMMARY: We report the MR imaging findings in a case of intracranial aspergillosis involving the internal auditory canal (IAC) and inner ear in an immunocompetent patient.
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