Volume : 09, Issue : 08, August – 2022
Title:
41.OTITIS EXTERNA, ENDING AS MALIGNANT DIAGNOSIS: A CASE REPORT OF ACUTE MYELOID LEUKAEMIA
Authors :
Rula Naqi, Hesham Yusuf, Fedaa Al-Sindi, Aly Rashed, Khalid Al-Sindi
Abstract :
Otitis externa (OE) is an inflammatory process of the external auditory canal.The prevalence of OE is around 10%. The aetiology is often multifactorial, including infectious and non-infectious factors. Pseudomonas aeruginosa and Staphylococcus aureus are the most common isolated organisms.
We are presenting a case report of a 36-year-old male, who presented to an otolaryngology clinic with a history of right-sided ear block, associated with severe otalgia and otorrhea, for more than a month. The ear canal was narrowed with boggy, pulsatile granulation tissue-like swelling postero-superiorly. The patient received multiple courses of antibiotics, topical, oral and parenteral elsewhere on the assumption of OE, but with no improvement. Accordingly, further investigations are warranted. Blood tests showed leukocytosis with 34% blast cells and marked monocytosis, along with anaemia and thrombocytopenia. Computed tomography (CT) temporal imaging showed opacification of the right middle ear cleft and right mastoid air cells, and a small ill-defined soft tissue density was noted within the left anterior meso-tympanic cavity. Then, a biopsy of the ear mass revealed myeloid sarcoma. Finally, flow cytometry confirmed the diagnosis of AML. The patient was referred to Bahrain Oncology Center as a case of myeloid sarcoma in the ear with concomitant AML. He received multiple cycles of chemotherapy. Repeated CT temporal imaging was done afterwards. It showed complete resolution of the previous right ear opacification and left ear soft tissue density. Thus, remission was achieved.
The atypical presentation of AML and myeloid sarcoma, reveals the importance of following up patient regularly and assessing the response to the treatment given. If there was no response, as in this case, thorough investigations should be done immediately, to reveal the hidden diagnosis.
Cite This Article:
Please cite this article in press Rula Naqi et al, Otitis Externa, Ending As Malignant Diagnosis: A Case Report Of Acute Myeloid Leukaemia., Indo Am. J. P. Sci, 2022; 09(8).
,
Number of Downloads : 10
References:
1. Wiegand S, Berner R, Schneider A, Lundershausen E, Dietz A. Otitis externa: investigation and evidence-based treatment. Deutsches Ärzteblatt International. 2019;116(13):224.
2. Medina-Blasini Y, Sharman T. Otitis Externa. 2020.
3. Ghossaini S. Treatment of Otitis Externa Webpage BMJ best practice 2021 [Available from: https://0x10clf0s-y-https-bestpractice-bmj-com.proxy.rcsibahrainelibrary.com/topics/en-gb/40.
4. Goguen LA. External otitis: Pathogenesis, clinical features, and diagnosis Uptodate: Uptodate; 2020 [updated March 2022. Available from: https://0x109lf0d-y-https-www-uptodate-com.proxy.rcsibahrainelibrary.com/contents/external-otitis-pathogenesis-clinical-features-and-diagnosis?search=otitis%20externa&source=search_result&selectedTitle=2~89&usage_type=default&display_rank=2#H277540.
5. Slengerik-Hansen J, Ovesen T. Acute external otitis as debut of acute myeloid leukemia-A case and review of the literature. International Journal of Pediatric Otorhinolaryngology. 2018;106:110-2.
6. Goguen LA. External otitis: Treatment Webpage: Uptodate; 2019 [updated March 2022. Available from: https://0x109lf0d-y-https-www-uptodate-com.proxy.rcsibahrainelibrary.com/contents/external-otitis-treatment?search=otitis%20externa&source=search_result&selectedTitle=1~89&usage_type=default&display_rank=1#H569884709.
7. Al Aaraj MS, Kelley C. Malignant Otitis Externa. 2020.
8. Maheshwari G. Unusual presentations of acute lymphoblastic leukemia in children: a study of 9 patients. American Society of Clinical Oncology; 2018.
9. Laurindo R, Souza S, Moura J, Tomita S, Fonseca LBd, Gutfilen B. Extramedullary relapse of acute myeloid leukemia mimicking a necrotizing external otitis: could mononuclear leukocyte scintigraphy be the best diagnostic method?☆. Brazilian Journal of Otorhinolaryngology. 2016;82:487-90.
10. Vakiti A, Mewawalla P. Acute myeloid leukemia. 2018.
11. Chen SM, Silverman DA, Jatana KR, Chiang T, Guinipero T, Hill N, et al. Myeloid sarcoma presenting as bilateral acute otitis externa in newly diagnosed acute myeloid leukemia. International Journal of Pediatric Otorhinolaryngology. 2019;122:126-9.
12. Kelly M, Advani R, Schuster-Bruce J, Crossley E, Lakhani R. Unilateral nasal obstruction: a rare presentation of acute myeloid leukaemia. Journal of Surgical Case Reports. 2021;2021(12):rjab581.
13. Cankaya H, Ugras S, Dilek I. Head and neck granulocytic sarcoma with acute myeloid leukemia: three rare cases. Ear, nose & throat journal. 2001;80(4):224-9.
14. Bahethi RR, Kinberg E, Kidwai S, Cosetti M, Wanna G, Perez E. Acute myeloid leukemia presenting as a spontaneous hemotympanum: A Case Report and review of the literature. Otolaryngology Case Reports. 2020;15:100155.
15. Chisholm KM. Myeloid sarcoma. Atlas of Genetics and Cytogenetics in Oncology and Haematology. 2019.
16. Almond LM, Charalampakis M, Ford SJ, Gourevitch D, Desai A. Myeloid sarcoma: presentation, diagnosis, and treatment. Clinical Lymphoma Myeloma and Leukemia. 2017;17(5):263-7.
17. Khan AA, Nazir S, Ahmed A. Relapse of acute myeloid leukemia presenting as acute otitis media. QJM: An International Journal of Medicine. 2010;103(7):533-4.
18. Klein JO. Otitis externa, otitis media, and mastoiditis. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. 2015:767.
19. Hasnaoui M, Mabrouk AB, Chelli J, Ammari FL, Lahmar R, Toumi A, et al. Necrotising otitis externa: A single centre experience. Journal of Otology. 2021;16(1):22-6.
20. Chennamadhavuni A LV, Shimanovsky A. Leukemia In: StatPearls [Internet]: Treasure Island (FL); 2021 [Available from: https://pubmed.ncbi.nlm.nih.gov/32809325/.
21. Waitzman AA. Otitis Externa – Epidemiology Webpage Medscape; [updated Apr 07, 2022 Available from: https://emedicine.medscape.com/article/994550-overview#a6.
22. Shallis RM, Wang R, Davidoff A, Ma X, Zeidan AM. Epidemiology of acute myeloid leukemia: recent progress and enduring challenges. Blood reviews. 2019;36:70-87.
23. Avni B, Koren-Michowitz M. Myeloid sarcoma: current approach and therapeutic options. Therapeutic Advances in Hematology. 2011;2(5):309-16.
24. Mozafari R, Alimoghaddam K, Sotoude H, Asadollahi-Amin A. A Lateral Neck Myeloid Sarcoma Presenting as Acute Otitis Externa. Archives of Iranian medicine. 2018;21(11):544.
25. Sandro Cinti AM, James Riddell,. Otitis externa, Chapter 11 – Infectious Diseases. Joel J. Heidelbaugh, editor. Online Elsevier 2008 25th, April, 2022. 25 p.
26. Yi M, Li A, Zhou L, Chu Q, Song Y, Wu K. The global burden and attributable risk factor analysis of acute myeloid leukemia in 195 countries and territories from 1990 to 2017: estimates based on the global burden of disease study 2017. Journal of hematology & oncology. 2020;13(1):1-16.
27. KELLER JL. Diseases of the External Ear. Pediatric Otolaryngology. 2007:23.
28. Faaij CM, Willemze AJ, Révész T, Balzarolo M, Tensen CP, Hoogeboom M, et al. Chemokine/chemokine receptor interactions in extramedullary leukaemia of the skin in childhood AML: differential roles for CCR2, CCR5, CXCR4 and CXCR7. Pediatric blood & cancer. 2010;55(2):344-8.
29. Stefanidakis M, Karjalainen K, Jaalouk DE, Gahmberg CG, O’Brien S, Pasqualini R, et al. Role of leukemia cell invadosome in extramedullary infiltration. Blood, The Journal of the American Society of Hematology. 2009;114(14):3008-17.
30. Delaunay J, Vey N, Leblanc T, Fenaux P, Rigal-Huguet Fo, Witz F, et al. Prognosis of inv (16)/t (16; 16) acute myeloid leukemia (AML): a survey of 110 cases from the French AML Intergroup. Blood. 2003;102(2):462-9.
31. Matsuda M, Huh Y, Ji R-R. Roles of inflammation, neurogenic inflammation, and neuroinflammation in pain. Journal of anesthesia. 2019;33(1):131-9.
32. Blumenreich MS. The white blood cell and differential count. Clinical Methods: The History, Physical, and Laboratory Examinations 3rd edition. 1990.
33. Khardori R. Infection in Patients With Diabetes Mellitus Online: Medscape; 2015 [updated Dec 16, 2015 Available from: https://emedicine.medscape.com/article/2122072-overview.
34. Van Kroonenburgh A, Van der Meer W, Bothof R, Van Tilburg M, Van Tongeren J, Postma A. Advanced imaging techniques in skull base osteomyelitis due to malignant otitis externa. Current radiology reports. 2018;6(1):1-14.
35. Harris AM, Bramley AM, Jain S, Arnold SR, Ampofo K, Self WH, et al., editors. Influence of antibiotics on the detection of bacteria by culture-based and culture-independent diagnostic tests in patients hospitalized with community-acquired pneumonia. Open forum infectious diseases; 2017: Oxford University Press.
36. Bola S, Rashid M, Hickey S. Optimising the use of otowicks in otitis externa. The Journal of Laryngology & Otology. 2017;131(9):809-12.
37. Antic D, Elezovic I, Milic N, Suvajdzic N, Vidovic A, Perunicic M, et al. Is there a “gold” standard treatment for patients with isolated myeloid sarcoma? Biomedicine & Pharmacotherapy. 2013;67(1):72-7.