Osteomyelitis of the base of the skull secondary to Aspergillus.

Malignant external otitis is a well-characterized entity, known for its insidious and morbid course in immunocompromized patients. Malignant external otitis occurs most commonly in elderly diabetics and is almost uniformly caused by Pseudomonas aeruginosa. If not recognized early in the immunocompromized patient, it can lead to extensive skull base osteomyelitis (SBO), with multiple cranial nerve neuropathies and eventual death. In patients presenting with multiple cranial nerve deficits, mortality ranges from 28% to 6O%.l Fungal SBO is rare, and the diagnosis can be delayed because cultures growing fungal pathogens are often interpreted incorrectly as an opportunistic colonization. This may lead to delayed treatment and greater morbidity for the patient. We present a patient with SBO secondary to Aspergillus and review the literature. His presentation was identical to that of pseudomonal necrotizing external otitis and SBO. However, his poor response to antipseudomonal therapy led to an eventual isolation and treatment of invasive aspergillosis.