Atypical Presentation of Fungal Skull Base Osteomyelitis: Middle Ear as the Primary Focus

Abstract

INTRODUCTION:Skull base osteomyelitis (SBO) is a complex condition seen in immunocompromised patients with severe mortality and morbidity. Fungal SBO is very rare and mostly sinogenic in origin. Otogenic (middle ear ) fungal SBO is exceptionally rare.This case report details a case of atypical fungal SBO due to mucormycosis originating in the middle ear with its unusual clinical course.

CASE REPORT: A 60 year old male with uncontrolled diabetes mellitus presented with left ear pain and multiple cranial nerve palsies. Initial imaging was suggestive of pansinusitis with SBO. Histopathology confirmed mucormycosis exclusively in the middle ear granulation tissue, not the sinuses, pinpointing an otogenic primary source.The patient received antifungal therapy with management of Diabetes Mellitus and other co-existing medical issues.

DISCUSSION:This case highlights an extreme rare case of fungal skull base osteomyelitis from middle ear origin.It underscores the importance of histopathological examination given the initial misleading radiological findings. The patient showed a favourable response with medical management of Diabetes Mellitus and antifungal therapy despite his initial grim neurological presentation with multiple cerebral infarcts defying his grave prognosis.

CONCLUSION: This case highlights that though fungal SBO aggressive symptoms and signs of fungal SBO can lead to severe complications.Inspite initial grim outlook, with vigilant management of underlying comorbid conditions and antifungal therapy there was remarkable clinical improvement.