case_images: PMC11746938_01
case_images: Axial temporal bone computed tomography (CT) scan. (A) Opacification in the attic (blue arrow). (B) Antrum is also opacified. (C) Few mastoid air cells have opacification (curve arrow), soft tissue density without any erosion in bony canal is seen (blue arrow), that was cerumen.
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case_images: High-resolution computed tomography of the temporal bone demonstrated opacification in the middle ear and mastoid air cells, without bone erosion (Figure 1).
case_images: Trans canal endoscopic view of tympanic membrane (TM) shows TM necrosis. Malleolus and tympanic cavity are apparent.
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case_images: Otoscopy on the 4th admission day, revealed total necrosis of the tympanic membrane with black discharge (Figure 2).
case_images: Colonies of 
  Candida tropicalis
  /Aspergillus flavus in Sabouraud dextrose agar culture medium related to primary middle ear biopsy at 35oc.
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case_images: PMC11746938_01_CCR3-13-e70101-g003.jpg
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case_images: The culture results yielded Candida and Aspergillus colonies (Figure 3).
case_images: (A) The antrum is opened and lateral semicircular canal is apparent. The black necrotic tissue is seen in the attic. (B) Three ossicles are shown. Handle and lateral process of malleolus, long process of incus, especially lentiform process, and capitulum are necrotic.
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case_images: Foot plate was preserved (Figure 4).
case_images: Diagram demonstrated the fluctuation in CRP and ESR levels, from day of admission to 2 weeks after discharge.
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case_images: Treatment response was regularly monitored with clinical signs and symptoms, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) as depicted in Figure 5.