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CLINICAL IMAGE
Year : 2020  |  Volume : 152  |  Issue : 7  |  Page : 194-195

Masquerading facial lesion: An unusual mycosis


Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India

Date of Submission20-Nov-2019
Date of Web Publication25-May-2021

Correspondence Address:
Shivaprakash M Rudramurthy
Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_2307_19

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How to cite this article:
Kanaujia R, Rudramurthy SM. Masquerading facial lesion: An unusual mycosis. Indian J Med Res 2020;152, Suppl S1:194-5

How to cite this URL:
Kanaujia R, Rudramurthy SM. Masquerading facial lesion: An unusual mycosis. Indian J Med Res [serial online] 2020 [cited 2021 Sep 24];152, Suppl S1:194-5. Available from: https://www.ijmr.org.in/text.asp?2020/152/7/194/316819

Consent to publish clinical information and image obtained from patient's parents.


An immunocompetent three yr old male child presented to the department of Paediatrics, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India in August 2017, with a one month history of progressive right-sided nasal swelling after trivial fall [Figure 1]A. Diagnostic biopsy revealed broad pauci-septate hyphae and Splendore–Hoeppli phenomenon [Figure 2]A. Differential diagnosis of mucormycosis, entomophthoromycosis, and pythiosis was made. In the absence of culture, the choice of antifungal was a dilemma. The patient received amphotericin B (AmB), itraconazole, terbinafine, and a 10% potassium iodide (KI) solution. After 40 days, culture yielded Conidiobolus coronatus [Figure 2]B and [Figure 2]C. AmB was stopped. As the lesions progressed [Figure 1]B, the itraconazole level was monitored by therapeutic drug monitoring (TDM). Dose was adjusted which led to resolution of symptoms without relapse [Figure 1]C. The course of rhinofacial entomophthoromycosis is chronic and TDM should be used as a guide for the azole levels. It should be differentiated from rapidly progressive mucormycosis as treatments for both diseases are different.
Figure 1: (A) Diffuse, bilateral swelling and enlargement of the nose with involvement of the cheeks. (B) After 25 days, progressive lesions with disfiguration of face and mid forehead and (C) After six months of antifungal therapy showing reduction in the size of swelling and marked improvement in facial deformity.

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Figure 2: (A) Periodic acid–Schiff stain showing Splendore–Hoeppli phenomenon characterized by granulomatous inflammation surrounded by eosinophilic material and aseptate hyphae (×400) (black arrow). (B) Sabouraud dextrose agar culture (37°C) showing multiple, flat, white, glabrous, radially furrowed colonies with satellite colonies at the periphery (green arrow). (C) Lactophenol cotton blue mount of Conidiobolus coronatus isolate, showing a characteristic globose conidia with a basal papilla borne singly on short slender conidiophores or free (×400) (red arrow).

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Acknowledgment: Authors acknowledge Dr Deepti Suri, department of Pediatrics, PGIMER, Chandigarh, for her assistance and providing the photographs of the patient.

Conflicts of Interest: None.


    Figures

  [Figure 1], [Figure 2]



 

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