Skull Base Mucormycosis in an Immunocompetent Patient: A Case Report and Literature Review

Abstract

To demonstrate the affection of skull base by mucormycosis in an immunocompetent individual. Mucormycosis is an opportunistic infection principally seen in immunocompromised individuals, but recently being increasingly recognized in otherwise healthy individuals. Skull base involvement secondary to otogenic nidus, mimicking otitis media was rarely reported. A 34 year-old male, an otherwise healthy patient presented with facial nerve palsy followed by trismus, neck swelling and neck stiffness. Radical mastoidectomy with tympanoplasty and Facial nerve decompression along with Endoscopic guided debridement of sinuses and pterygopalatine fossa followed by medical treatment for 14 weeks. Facial nerve functioning, dry ear canal and relief from other symptoms. Surgical debridement and post op Anti fungal treatment improved the facial nerve function to House brackmann grade-II and also provided relief from trismus and stiffness and improved the overall general condition of the patient. Mucor is a saprophytic organism, which can cause extensive progression, regardless of the immune status. To the best of our knowledge, this is one of the very few rare cases that have been reported in the context of skull base mucormycosis in immunocompetent individuals. Surgical debridement followed by anti fungal therapy continues to remain the mainstay of treatment.

Keywords: Immunocompetent; Mucormycosis; Otitis media; Pterygopalatine fossa.

Fig. 1

CT paranasal sinuses showing opacity involving sphenoid sinuses

Fig. 2

CT temporal bones showing soft tissue density noted filling the middle ear cavity and mastoid air cells

Fig. 3

CT neck showing diffuse cellulitis involving left parapharyngeal space, left carotid space and submandibular space