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case_images: T1 fast spin echo brain magnetic resonance imaging showing soft tissue or fluid density material within the left middle ear cavity and left mastoid air cells as well as bony demineralization of the ossicular chain (as denoted by the white arrow).
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case_images: Subsequent magnetic resonance imaging of the brain confirmed the presence of a left ear canal soft tissue mass with associated tympanomastoid opacification (Fig. 1).
case_images: Small, ovoid, narrow-based budding yeast imbedded within either monocytes or macrophages (as depicted by the arrows in Fig. 2A and on Fig. 2B).
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case_images: He was initially started on broad empiric antibiotic coverage by his primary otolaryngology team when formal histopathology returned, surprisingly revealing numerous intracellular yeasts with invasion into soft tissue and ossicular bones, consistent with histoplasmosis (Fig. 2).
case_images: Potato dextrose agar showing growth of Histoplasma capsulatum after several weeks. Characteristic white cotton-like colonies can readily be seen (Fig. 3A). With the passage of time, transitions in color can occur from a whitish appearance (Fig. 3B) to a gray to brownish appearance (Fig. 3C).
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case_images: Anaerococcus species, Parvimonas micra, and Prevotella species), prompting tailoring of his broad bacterial coverage to ampicillin-sulbactam 3 g intravenously every 6 h for concurrent bacterial superinfection. After several weeks, Histoplasma capsulatum ultimately grew from operative tissue cultures as well to further confirm the primary underlying diagnosis of Histoplasma otomastoiditis (Fig. 3).