Scedosporium Apiospermum: A Rare Cause of Necrotizing Otitis Externa. Our Experience and A Review of the Current Literature

Abstract Necrotizing otitis externa (NOE) is a severe and progressive infection of the external auditory canal that poses significant diagnostic and therapeutic challenges, particularly when caused by rare pathogens such as Scedosporium apiospermum . This case report details an 84-year-old diabetic male with NOE treated with a combination of oral and topical Voriconazole after multiple ineffective antibiotic therapies. The consequent literature review identifies and analyzes 8 cases of NOE caused by S. apiospermum , revealing significant challenges in diagnosis and management. Diagnostic delays in NOE caused by Scedosporium apiospermum were common, leading to prolonged empirical antibiotic therapy in most cases. The follow-up duration was very long, with high rates of morbidity and mortality, including serious complications. Voriconazole emerged as the most effective antifungal treatment, though its use is associated with substantial risks, necessitating careful monitoring. Our findings underscore the importance of considering fungal etiologies in persistent NOE and emphasize the need for repeated ear swabs and targeted therapy to improve patient outcomes. The results highlight a critical gap in standardized diagnostic and therapeutic protocols, advocating for more rigorous evaluation and management strategies in cases of suspected Scedosporium infections.