Necrotizing external otitis on a Crohn's disease patient treated with infliximab.

This letter is about a 27 years old female with the diagnosis of Crohn's disease since July 2004, involving the duodenum, ileum and right colon. She was first treated with Mesalamine (1 g 3 id for 20 d, suspended because of the absence of efficacy), Prednisolone (four episode treatment, tapered), Azathioprine (since July 2004, up to 2.5 mg/Kg/d). She had four previous admissions at our hospital: first in July 2004, by the time the diagnosis was established, with diarrhoea, abdominal pain, vomiting and fever; the second in November 2004 with the same symptoms; the third (January 2005) and the fourth (June 2005) admissions were because of vomiting due to duodenum estenosis. After surgical consultation, she was treated with endoscopic dilatation and started with Infliximab (5 mg/Kg 0, 2, 6 weeks). After that, the patient did well and she was maintained on Infliximab (8/8 weeks), Azathiprine (100 mg id) and Omeprazol (40 mg id). At the time of this admission, she complained of left otalgia, otorrohea, and fever; she had no gastrointestinal complains. The physical examination showed fever and the external ear canal had granulation tissue (Fig. 1). The laboratory tests revealed a normocytic anemia (haemoglobin 11.2 g/dL; MCV 91.3 fl), with no leucocytosis and the eritrocyte sedimentation rate was normal; CRP (c-reactive protein)was increased (15.65 mg/dL). The tuberculosis skin test (PPD test) was negative, the culture of the ear secretions was negative, and chest X ray was also normal. An ear CT Scan revealed left mastoid sclerosis with the tympanic antrum, tympanic cavity and external auditory canal filed with soft tissue like material. The tegmen timpani and ossicles were normal but the posterior and interior wall of external auditory canal were irregular. Gallium scintigraphy revealed intense gallium uptake on the left external auditory canal extending to the mastoid and petrous part of the temporal bone, compatible