Epistaxis in the Presence of a Petrous Internal Carotid Artery Pseudoaneurysm: An Unusual Complication of Malignant Otitis Externa

Abstract

Patient: A 65-year-old patient with a background of refractory malignant otitis externa and diabetes was admitted with recurrent epistaxis. He was diagnosed with adenocarcinoma and treated with parotidectomy and radiotherapy in 1972. The malignant otitis externa was treated with a mastoidectomy and antibiotic therapy in 2007. He was discharged on intravenous Tazocin and metronidazole for 1 month and converted to oral metronidazole and ciprofloxacin. In 2008, he developed epistaxis that required mucosal cauterization and sphenopalatine artery ligation. Before discharge, he had brisk epistaxis from his left nostril. Subsequently he underwent an MRI that suggested the presence of a pseudoaneurysm. He was transferred to neurosurgery, where a formal cerebral angiogram confirmed the presence of an internal carotid pseudoaneurysm. The next day he passed a balloon occlusion test and had his left internal carotid artery occluded. He was given 2 months of oral ciprofloxacin and intravenous meropenem in hospital and oral ciprofloxacin with Augmentin for 7 months after discharge.