Cholesteatoma of the Middle Ear Associated with Mucormycosis: A Case Report

Introduction: Mucormycosis is usually a serious opportunistic infection caused by fungi of the order Mucorales, more common in immunocompromised and diabetic patients. Clinical manifestations may vary, but invasion of the nose and paranasal sinuses are the most common presentations. The involvement of the middle ear and mastoid in nondiabetic patients is very rare. Objectives: We report a case of mucormycosis of the middle ear and mastoid in an immunocompetent patient. Resumed Report: A 41-year-old female, without comorbidities, history of various surgical interventions in right ear due to chronic otitis media with cholesteatoma, and a retroauricular fistula was studied. In 2013, she was referred to Antonio Pedro University Hospital for surgical treatment. The complaints were ipsilateral otorrhea, otalgia, and hearing loss. A radical mastoidectomy and fistula repair were performed in January 2014. The biopsy showed cholesteatoma associated with mucormycosis, treated with oral fluconazole. Regular follow-up with regular cleansing of the remaining cavity, and she is disease free till the present date. Conclusion: The mucormycosis of the middle ear and mastoid, in nondiabetic patients, seems to be noninvasive and nonfatal. The infection can be insidious and with similar symptoms to chronic otitis media with cholesteatoma. Since it is a rare condition, first clinical suspicion is difficult. Treatment usually involves intravenous amphotericin, affected tissue's radical debridement and risk factors control. However, in these noninvasive cases, radical debridement with or without amphotericin seems appropriate, in addition to a regular follow-up to evaluate recurrences.