Otocerebral mucormycosis--a case report.

Mucormycosis is an often fatal infection caused by ubiquitous organisms of the order Mucorales. Infection is most commonly seen in the immunocompromised host, particularly in the setting of diabetic ketoacidosis. The most common presentation is with rhinocerebral involvement. We here report a case of otocerebral mucormycosis occurring in an elderly man with maturity onset diabetes who was not acidotic. The unusual site of infection delayed diagnosis until the pons had been invaded by the infecting organism which was demonstrated as a hypodense area on CT scan. Consequently radical excision of infected tissue was not feasible and the patient died. At post-mortem examination there was extensive infection and infarction of the parotid gland, inner ear and pons associated with arterial invasion by the fungus and septic cavernous sinus thrombosis. The case is described to demonstrate the existence of other modes of neurological presentation of mucormycosis apart from the well recognized rhinocerebral form. Early diagnosis is the key to successful therapy.