Novel use of a swimming pool biocide in the treatment of a rare fungal mastoiditis

Objective. To describe an extremely rare fungal mastoiditis caused by Lecythophora hoffmannii, its recalcitrant behavior to therapy, and eventual successful treatment with adjunctive therapy using polyhexamethylene biguanide (a common swimming pool biocide). Study Design: Case report and review of literature of human Lecythophora hoffinannii infections. Methods. Medline database was searched using the keywords Lecythophora and hoffinannii. All articles that described Lecythophora hoffinannii as the cause of human infection at any site were identified. Literature and patient's records were considered for complete data review and extraction. Results: We present the second known case in the literature of a human infection with Lecythophora holfmannii. We also present the process to definitively identify and then to successfully eradicate this unusual fungal infection using polyhexamethylene biguanide as adjunctive treatment. Conclusions: Successful treatment of a chronic Lecythophora hoffmannii fungal mastoiditis involved a combination of radical surgical removal of all apparent infected tissue along with local treatments with polyhexamethylene biguanide, a common swimming pool biocide agent under the brand name Baquacil (Avecia, Manchester, United Kingdom). Given the prolonged course of treatment, this report particularly stresses the importance of concurrent surgery combined with creative local antimicrobial therapy to eliminate an unusual fungal infection in an immunocompetent host.