Intratemporal Complications of Acute Otitis Media in a Patient with Mannose-Binding Lectin Deficiency and IgG3 Subclass Deficiency

Objective: Mannose-binding lectin (MBL) and IgG subclass deficiency were shown to be associated with an increased susceptibility to infections. To our knowledge, the association between intratemporal complications of acute otitis media (AOM) and MBL and IgG subclass deficiency has never been reported. Study Design: Retrospective case review. Patient and Methods: A 33-year-old woman presented with recurrent vertigo and unilateral hearing loss. Under the clinical picture of Meniere disease a saccotomy and mastoidectomy was performed. Because of bacterial infection of the mastoid cavity, the middle and inner ear, high-dose antibiotics were given. However, two consecutive middle and mastoid operations were necessary. Due to the clinical course, intensive immunologic work-up was done and MBL and IgG3 subclass deficiency were diagnosed. Results: The woman was given monthly IVIG therapy for the total of five courses. After three courses of IVIG therapy, revision ear surgery and prosthetic middle ear reconstruction was successfully done. The postoperative course was uneventful. At present, the patient is doing well after the cessation of IVIG therapy for 24 months. She is not suffering from vertigo, with stable hearing function. Conclusions: We reported the case of intratemporal complications of AOM. Immunologic work-up revealed MBL and IgG3 subclass deficiency. Treatment with monthly IVIG improved the clinical course significantly.