Analysis of cerebrospinal fluid (CSF) collected
from the cerebello-medullary cistern revealed a
marked mixed cell pleocytosis (655 cells/lL, reported
RI, 0–3 cells/lL1) consisting of 71% nondegenerate
neutrophils, 22% macrophages, and 7% lymphocytes,
including reactive forms, with an increased total protein
(165 mg/dL, reported RI, <30 mg/dL1). An otoscopic
examination demonstrated a large amount of
debris and a large, solid white mass in the horizontal
ear canal of the left ear (Figure 2). Several biopsies
were obtained and submitted for histopathologic
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