Intratemporal mucormycosis: a rare COVID-19 sequelae

Abstract

A man in his 50s presented with a 2-month history of left ear discharge associated with hearing loss and weakness of left half of face since 15 days. The patient had no comorbidities, but he gave history of being treated for COVID-19 pneumonia 2 months ago post which he started experiencing left-sided aural symptoms. Clinical examination of ear revealed a subtotal perforation with multiple granulations in middle ear. Facial nerve examination revealed grade 3 lower motor neuron palsy. The biopsy of the granulations was sent to aid in diagnosis which later confirmed left ear mucormycosis. Otological involvement with facial palsy and sudden sensorineural loss in a patient with prior history of COVID-19 has not been reported until in literature. We try to communicate our experience to bridge the gap in understanding and managing this extremely rare occurrence of mucormycosis in the ear of a patient diagnosed with COVID-19 infection.

Keywords: COVID-19; Ear, nose and throat; Ear, nose and throat/otolaryngology; Otolaryngology / ENT.

Figure 1

Clinical pictures. (A) Otoendoscopy of left ear showing subtotal perforation with granulations in middle ear cavity (marked arrow). (B) Grade 3 left-sided facial palsy on initial presentation.

Figure 2

Diagnostic workup of patient. (A) Pure tone audiogram showing profound mixed hearing loss in left ear. (B) Non-enhancing soft tissue densities in left tympanic cavity and mastoid air cells with air fluid levels.

Figure 3

Histopathology suggestive of invasive mucormycosis. (A) Fungal colonies with aseptate broad hyphae, having obtuse angle branching (arrow). (B): Fungal colonies are surrounded by neutrophils, plasma cells. (C) Stratified squamous epithelium and subepithelium invaded by fungal colonies.

Figure 4

Intraoperative pictures of canal wall down mastoidectomy and facial nerve decompression. (A) Granulations seen over entire length of vertical segment of facial nerve, attic, middle ear and dural—plate. (B) Mastoid cavity obliterated using temporalis fascia.