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

Mucormycosis is the common name given to clinical disease caused by fungi of the order Mucoraceae of class zygomycetes. Mucormycosis is a life threatening fungal infection which commonly affects the Immunocompromised hosts almost uniformly in developing as well as industrialised countries. Mucorales are distributed into six families all of which can cause cutaneous and deep fungal infections. Out of the six families Rhizopus oryzae is the commonest cause of infection. Among the other species that are isolated include Rhizopus microsporus var. rhizopodiformis, Absidia corymbifera, Apophysomyces elegans, Mucor species, and Rhizomucor [1]. Mucormycosis is seen more commonly in the nose and paranasal sinuses, whereas candida and aspergillus fungal infection, which are rather commoner [2,3], are seen in the external auditory canal. The invasive variant of mucormycosis is commonly seen in diabetic patients. Mucormycosis involving the middle ear is a rare clinical entity. Probable portal of entry to the middle ear is either from nasopharynx through Eustachian tube or through the already existing perforated tympanic membrane [4]. The rarity of involvement of the middle ear makes it difficult for the clinician to suspect the same as the principal diagnosis. Clinical presentation may be similar to Chronic Otitis Media with probably the chief complaint of predominant ear pain with referral to the mastoid and upper neck. Further complication of Mucormycosis of the middle ear involvement in terms of intracranial extension with brain and venous sinuses involvement further complicates the presentation adding to the diagnostic dilemma. Early diagnosis is the mainstay of successful therapy which involves surgical debridement and administration of antifungals like Amphotericin B [4,5].