Mycoplasma Hominis: A Rare Case of Acute Otitis Media and Facial Nerve Paralysis

Abstract

Facial paralysis secondary to acute otitis media (AOM) is rare in the post-antibiotic era.1,2 In immunosuppressed patients, atypical bacteria are more commonly encountered as the cause. Mycoplasma hominis, normally found in the genitourinary tract, uncommonly causes extragenital infection.3 We report a case of AOM secondary to M. hominis, complicated by facial paralysis in an immunosuppressed patient. A 24-year-old male with multiple sclerosis, on rituximab, presented to the emergency department with otalgia and facial paralysis. He was diagnosed with Bell’s palsy and subsequently referred to the otolaryngology service. Examination revealed right facial paralysis and purulent otorrhea. Computed tomography (CT) of the temporal bone showed right tympanic and mastoid opacification. The patient was admitted and started on IV ampicillin/sulbactam, IV dexamethasone, and ciprofloxacin/dexamethasone otic drops. Debridement and examination under anesthesia revealed a right tympanic membrane perforation and granulation tissue. Biopsy and cultures were obtained. Final cultures were positive for Mycoplasma hominis. Facial paralysis is an uncommon complication of AOM but typically resolves once appropriate antibiotic therapy is regimented. Because Mycoplasma can be missed on routine culture, clinicians should consider workup for atypical organisms in settings of immunosuppression so appropriate antibiotic therapy can be initiated.