Chronic otomastoiditis and otitis externa caused by Achromobacter xylosoxidans

Achromobacter xylosoxidans is an uncommon cause of infection that has not previously been reported as a cause of chronic otitis externa and chronic otomastoiditis. We present the unique case of a 15-year old male with a remote history of multiple tympanostomy tube placements for recurrent acute otitis media. He presented with chronic right sided otorrhea and otalgia. A culture of the otorrhea isolated multi-drug resistant A. xylosoxidans on multiple culture isolates. The patient failed treatment with otic preparations, and topical and IV antibiotics. Imaging including CT and MRI reaffirmed ongoing infection. Due to the recalcitrant infection, he ultimately underwent tympanoplasty with intact canal wall mastoidectomy to achieve local control of the infection, with repeat cultures demonstrating A. xylosoxidans. At 3-month follow-up he was asymptomatic, and imaging with bone scan and SPECT/CT did not show evidence of osteomyelitis within the temporal bone. Immunologic work-up did not reveal any underlying immunodeficiency. Despite being characterized as an opportunistic organism with low virulence, A. xylosoxidans is capable of infecting patients without any underlying immunodeficiency, and it can be difficult to eradicate.