Rare cause of temporal cephalgia -diagnosis and therapeutic reserves

Case presentation  The case of a 75-year-old patient who presented with right-sided otalgia, otorrhea and hearing loss is presented. The patient developed a prolonged course of refractory otitis externa. CT suggested a carcinoma of the external auditory canal, however, biopsy revealed no malignancy and P. aeruginosa was detected. Local care and systemic antibiotic therapy resulted in an almost complete recovery of the symptoms and findings.

Two weeks later, the patient presented with severe right temporal pain. CT revealed osteolysis of the right temporomandibular joint. Biopsy again detected P. aeruginosa and the patient was treated with Meropenem. Thereafter, the patient developed peripheral facial nerve palsy on the right side. Mastoidectomy with decompression of the facial nerve was performed. Under sustained therapy with Meropenem, the facial nerve palsy completely recovered.

After 4 months, the patient presented with dysphagia and weight loss as well as caudal cranial nerve pareses. CT and MRI showed a progression of the destructive bone infiltrative inflammation, now crossing the midline. Interventional CT angiography with biopsy revealed the presence of P. aeruginosa again. Lastly, after long-term systemic antibiotic therapy and hyperbaric oxygen therapy, the clinical symptoms improved significantly.

Conclusion  The antibiotic therapy should be adapted to the smear and administered for a sufficiently long time.

Histopathological examinations are essential to distinguish from autoimmune disorders or malignancy.

Hyperbaric oxygen therapy is a promising salvage therapy for recurrent disease.

Publication History

Article published online:
24 May 2022