Otomycosis: subdermal growth in calcified mass.

Reports on clear identification of fungi in subdermal tissue in chronic fungal external otitis are rare in recent years. Our patient was an immunocompetent adult male with an 8 year history of chronic otitis externa who presented with pustules on the external auditory canal (EAC) and necrosis and perforation of the tympanic membrane. Type I tympanoplasty was performed, but wound healing was delayed and swelling of the EAC occurred. Incision biopsy and staining (Gomori-Grocott and PAS) revealed fungal hyphae within small, calcified, subepidermal masses. A 3 month course of oral itraconazole was effective in healing the lesion. Calcification, a rarely reported finding in otomycosis, may represent a protective reaction against topical use of antifungal drugs.