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Am. J. Trop. Med. Hyg., 75(2), 2006, pp. 270-272
Copyright © 2006 by The American Society of Tropical Medicine and Hygiene

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

DIANE VAN DER VLIET, ANNE-SOPHIE LE GUERN, SYLVIE FREITAG, NICOLAS GOUNOD, AUDREY THERBY, HERVE DARIE, AND PIERRE A. BUFFET*
Institut Pasteur Medical Center, Paris, France, Department of Pathology, Dermatology Department, and Infectious Diseases Department, Necker Hospital, Assistance-Publique, Hôpitaux de Paris, Paris, France

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.

Received December 30, 2005. Accepted for publication March 23, 2006.

* Address correspondence to Pierre A. Buffet, 211 Rue de Vaugirard, 75015 Paris, France. E-mail: pabuffet{at}pasteur.fr

Authors’ addresses: Diane van der Vliet, Anne-Sophie Le Guern, Herve Darie, and Pierre A. Buffet, Institut Pasteur Medical Center, Paris, France. Sylvie Freitag, Department of Pathology, Necker Hospital, Assistance-Publique, Hôpitaux de Paris, Paris, France. Nicolas Gounod, Dermatology Department, Necker Hospital, Assistance-Publique, Hôpitaux de Paris, Paris, France. Audrey Therby, Infectious Diseases Department, Necker Hospital, Assistance-Publique, Hôpitaux de Paris, Paris, France.

Reprint requests: Pierre A. Buffet, 211 Rue de Vaugirard, 75015 Paris, France, Telephone: 33-1-45-68-81-15, Fax: 33-1-40-61-30-19. E-mail: pabuffet{at}pasteur.fr.






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