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Clinical Problem Solving: Pathology
Feb 2012

Pathology Quiz Case 1: Diagnosis

Author Affiliations


Arch Otolaryngol Head Neck Surg. 2012;138(2):204-205. doi:10.1001/archoto.2011.1222b

Diagnosis: Actinomycosis osteomyelitis of the temporal bone

Infectious osteomyelitis of the head and neck is uncommon and, before the advent of effective antibiotics, was often fatal. Even today, mortality remains high owing to the aggressive nature of the disease and delays in diagnosis. The disease is generally associated with an immunocompromised state. Temporal bone osteomyelitis (TBO) is most commonly associated with malignant otitis externa in patients with diabetes mellitus. The usual pathogen is Pseudomonas aeruginosa although P mirabilis, Klebsiella species , and staphylococci are also commonly isolated in polymicrobial infections.1 Less commonly, fungal or mixed fungal-bacterial infections cause TBO with Aspergillus fumigatus as the primary fungal pathogen.2