PMC8068535_01
The patient's ear upon presentation.
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One week later, she returned to the emergency department after developing a persistent fever of 38 C, vomiting, abdominal pain, right ear discoloration for three days, which was bluish to dark in color, followed by discharge two days later, and an ear swelling (Figure 1).
CT scan showing diffuse left side periauricular swelling.
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The CT scan showed a heterogenous density, diffuse enhancement, periauricular soft tissue swelling, and fat stranding of the right ear (Figure 2).
T2 MRI with no contrast showing significant inflammatory changes in the right ear canal, periauricular region.
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It included MRI with no contrast (Figure 3), MRI using gadolinium-contrast media (Figure 4), and diffusion-weighted imaging (DWI) (Figure 5).
T1 MRI with gadolinium contrast showing significant inflammatory changes in the right ear canal, periauricular region.
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It included MRI with no contrast (Figure 3), MRI using gadolinium-contrast media (Figure 4), and diffusion-weighted imaging (DWI) (Figure 5).
Diffusion-weighted imaging showing significant inflammatory changes in the right ear canal, periauricular region.
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It included MRI with no contrast (Figure 3), MRI using gadolinium-contrast media (Figure 4), and diffusion-weighted imaging (DWI) (Figure 5).
Intraoperative wound closure with pack and drains inserted.
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The excision was done with a safe margin of around 5-7 mm, and then primary closure of the surgical defect with preservation of the patency of external auditory canal was done (Figure 6).
Necrotic right ear auricle after excision.
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The excised ear (Figure 7) was sent for histopathology and reported extensive necrosis with acute on top of chronic inflammation, heavy infiltration of neutrophils, and particles of mucormycosis-like were seen.
(a) Day 2 postoperatively showing packing of the ear and suture. (b) Day 45 postoperatively, showing complete healing of the wound with no discharge or inflammatory signs.
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On the second postoperative day, she was extubated, drain was removed, and ear drops and sterile packs were inserted to keep the external auditory canal patent (Figure 8).
Day 45 view of the right external auditory canal with an intact tympanic membrane.
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MRI, microscopic ear examination, and numerous aural swabs and blood cultures revealed no definitive recurrence of mucormycosis, and the wound healed very well with an intact tympanic membrane (Figure 9). Monthly follow-ups showed improvement of the facial palsy to HB grade III, and a plan for artificial auricle is set to occur in the following months before the age of five.