Malignant External Otitis Complicated by Severe Allergic Reaction to Antibiotic Therapy

Malignant external otitis (MEO), also known as necrotizing otitis externa, is an aggressive infection of the external auditory canal and skull base, typically affecting elderly diabetic or immunocompromised patients. We present a case of an 88-year-old non-diabetic woman diagnosed with MEO whose management was complicated by a severe allergic reaction to systemic antibiotic therapy. The patient initially presented with severe otalgia and purulent otorrhea of the right ear, unresponsive to conventional treatment. Otoscopic examination revealed granulation tissue at the osseocartilaginous junction of the external auditory canal. Computed tomography (CT) confirmed temporal bone osteomyelitis consistent with MEO. During hospitalization, the patient developed a severe generalized allergic dermatitis requiring discontinuation of all antibiotics and temporary transfer to the dermatology department. Following stabilization, treatment was resumed with intravenous ciprofloxacin and vancomycin, resulting in progressive clinical improvement and complete recovery after prolonged outpatient therapy. This case highlights the importance of individualized therapeutic strategies in MEO, particularly in elderly patients with atypical presentations and treatment-limiting complications.