PSEUDOMONAS AERUGINOSA OTOCHONDRITIS COMPLICATING LOCALIZED CUTANEOUS LEISHMANIASIS: PREVENTION OF MUTILATION BY EARLY ANTIBIOTIC THERAPY

Abstract. A patient with an ulcerated cutaneous leishmaniasis of the pinna had suppurative otochondritis after a first unsuccessful course of treatment with meglumine antimoniate. Although the Leishmania ulceration healed after a second course of meglumine antimoniate, and despite three oral dicloxacillin or pristinamycin courses, the otochondritis extended and an abscess developed. Pus from the abscess revealed a pure culture of Pseudomonas aeruginosa. Five days of oral ciprofloxacin plus rifampin led to a marked improvement. The P. aeruginosa isolate was sensitive to ciprofloxacin but fully resistant to rifampin. Healing with minimal mutilation was obtained at the end of a six-week course of multiple antibiotic therapy. Pseudomonas aeruginosa otochondritis was a co-factor of cartilage mutilation in this patient. Thus, infection with P. aeruginosa should be promptly treated when present in tender cutaneous or mucosal leishmaniasis lesions near cartilaginous areas. Localized cutaneous leishmaniasis (LCL) of the ear is char-acterized by a single ulceration without mucosal or lymphatic involvement.1 When progressing on the ear, LCL often in-volves cartilagenous structures, spontaneously lasts for months to years, and may cause severe mutilation.2 This case report suggests that Pseudomonas aeruginosa secondary in