Otocerebral Mucormycosis: A Rare Case in a Diabetic Patient with Unusual Presentation

Abstract

Mucor is a saprophytic fungus. Although it commonly invades the nose and the paranasal sinuses, cutaneous, pulmonary or gastrointestinal lesions may also be seen and haematogenous spread to other sites can also occur. The predisposing factors include Diabetes Mellitus and other conditions causing immunocompromised state. However, rare cases without any underlying disorder have been also reported. This case is described to demonstrate rarer neurological presentation of Oto-cerebral Mucormycosis rather than the well recognized rhino-orbito-cerebral form. Early diagnosis and institution of treatment is the mainstay to successful therapy.

Auricular mucormycosis complicated by parotid abscess and facial paralysis: A very rare case report

“…The rhino‐orbito‐cerebral localization is the most frequent (40% of cases) 2,6 . Other locations have been reported, including cutaneous, pulmonary, disseminated, gastrointestinal, and miscellaneous 2,7 . For the otologic location, several hypotheses have been suggested: either a passage of the fungal spores from the sinonasal cavities to the middle ear via the eustachian tube, or their penetration to the middle ear through a perforation of the tympanic membrane, or an auricular mucormycosis invading the middle ear and the mastoid 8,9 as in our case.…”

“…Clinically, otologic mucormycosis may manifest as refractory otitis externa involving the pinna and external auditory canal giving a blackish necrotic appearance with skin scaling 9 . It may be presented as a middle ear cholesteatoma with foul‐smelling otorrhea and otalgia 5,7,10 . Endocranial or skull base extension indicates a severe infection with cranial nerve damage, with or without neurological signs.…”

“…9 It may be presented as a middle ear cholesteatoma with foul-smelling otorrhea and otalgia. 5,7,10 Endocranial or skull base extension indicates a severe infection with cranial nerve damage, with or without neurological signs. The particularity of our observation consists of the auricular cutaneous starting point with involvement of the external ear and the large extension to the parotid, retro auricular and temporal regions.…”

Auricular mucormycosis complicated by parotid abscess and facial paralysis: A very rare case report

“…The rhino-orbito-cerebral localization is the most frequent (40% of cases) [5]. Other locations have been reported, including cutaneous, pulmonary, disseminated, gastrointestinal and miscellaneous [6]. For the otologic location, several hypotheses have been suggested: either a passage of the fungal spores from the sinonasal cavities to the middle ear via the eustachian tube, or their penetration to the middle ear through a perforation of the tympanic membrane, or an auricular mucormycosis invading the middle ear and the mastoid [7,8] as in our case.…”

“…Clinically, otologic mucormycosis may manifest as refractory otitis externa involving the pinna and external auditory canal giving a blackish necrotic appearance with skin scaling [8]. It may be presented as a middle ear cholesteatoma with foul-smelling otorrhea and otalgia [4,6,9]. Endocranial or skull base extension indicates a severe infection with cranial nerve damage, with or without neurological signs.…”