Indian Journal of Medical Research

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

Masquerading facial lesion: An unusual mycosis


Rimjhim Kanaujia, Shivaprakash M Rudramurthy 
 Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India

Correspondence Address:
Shivaprakash M Rudramurthy
Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012
India




How to cite this article:
Kanaujia R, Rudramurthy SM. Masquerading facial lesion: An unusual mycosis.Indian J Med Res 2020;152:194-195


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 23 ];152:194-195
Available from: https://www.ijmr.org.in/text.asp?2020/152/7/194/316819


Full Text

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}{Figure 2}

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.