A Rare Case of Facial Palsy Due to Mucormycosis

Abstract

A very uncommon instance of facial nerve palsy involving isolated temporal bone with associated uncontrolled diabetes mellitus has been noticed. A 53-year-old diabetic male presented himself with facial asymmetry, ear pain, and discharge in the right ear of one-month duration. Clinical examination revealed grade IV [House-Brackmann] right sided facial palsy, and otoscopy of small central perforation. Clinically acute otitis media with facial palsy diagnosis was made. There was minimal response to medical treatment. As per CT scan and audiometry findings, patient was subjected for exploratory mastoidectomy showing pale granulation tissue involving geniculate ganglion of facial nerve. The histopathology was suggestive of mucormycosis, an unusual presentation in middle ear. The patient was treated with injectable Amphotericin B. This case highlights a rare cause of isolated facial palsy and physicians should be aware of such atypical clinical presentation.

Temporal Bone Mucormycosis

“…2,3 The third patient, who presented with 1 month duration of facial weakness, had only mild improvement of his asymmetry and eye closure postoperatively with no ultimate change in his HB grade of IV/ VI. 4 All 3 patients survived.…”

“…1 Reviewing previously described otologic mucormycosis within the literature, 5 of the 9 patients presented with purulent otorrhea and debris-filled external auditory canal, with intraoperative findings of middle ear and mastoid granulation tissue. [1][2][3][4][5] The remaining 4 cases exhibited no otologic signs or symptoms, all with evidence of a rhinologic origin of the mucormycosis, and have been the only cases that have resulted in death. [6][7][8][9] For these cases, temporal bone pathology was noted on imaging and mucormycosis specificially on autopsy.…”

“…8 The remaining 8 of cases did not report culture results. [1][2][3][4][5][6][7]9 It is not uncommon for zygomycete fungus to fail to grow in cultures, even from obviously infected tissues, but for unknown reasons. 13 Interestingly, histologic findings of necrosis, vasculitis, angioinvasion, and infarction, the hallmarks of mucormycosis, were infrequently noted.…”

“…Of the 3 previously reported cases of facial nerve paresis with isolated temporal bone mucormycosis, all patients were middle-aged, poorly controlled diabetics, and presented with otorrhea and facial asymmetry. [2][3][4] Each patient underwent a tympanomastoidectomy and was treated with IV antifungals postoperatively. Two patients, in contrast to our case, demonstrated improvement in their facial function at last follow-up.…”

“…To our knowledge, only 9 cases of mucormycosis of the temporal bone have been reported in the literature. [1][2][3][4][5][6][7][8][9] Of these 9, two were reported in non-immunocompromised patients, and 3 patients demonstrated facial nerve palsies. [3][4][5] We present the case of a 71-year-old woman with poorly controlled diabetes who presented with a seizure-like episode, otorrhea, and subsequent facial nerve weakness.…”