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Phycomycosis infections caused by the fungi Rhizopus and Mucor are commonly termed mucormycosis. Mucormycosis infections exhibit a rapidly progressive course characterized by angioinvasion and necrosis. The rhinocerebral form has been described thoroughly in the literature. However, there exists another order of Phycomycetes, the Entomophthorales, which rarely cause clinical disease. Their infection is indolent and is associated with granulomatous inflammation and a protracted clinical course. Presented here is a rare case of suspected Canidiobolus coronato infection occurring in the maxillofacial region of a previously healthy male. The authors believe this to be the first reported case occurring in the United States. Because of the poorly documented natural history of this infection and the patient's relative intolerance to parenteral antifungal therapy, a multidisciplinary therapeutic approach was designed. It consisted of long-term, low-dosage amphotericin-B, hyperbaric oxygen and sequential surgical debridements. This unusual disease entity must now be considered in the differential diagnosis of granulomatous disorders of the head and neck.

Subcutaneous abscesses occurred at hip and deltoid injection sites in 13 student nurse assistants following practice injections. Mycobacterium chelonei was isolated from three cases and was the presumptive pathogen in other temporally clustered cases with similar clinical findings. A 1,000 cc bottle of 0.9 N saline used as a source for practice injection solution was the apparent source of the organism.Presenting findings included tenderness (7), swelling (7), fever (3), adenopathy (1) and weight loss (1). All cases were characterized by long incubation periods (6 to 16 weeks) and delayed resolution (mean 8.8 months), and required surgical drainage or wedge excision for therapy. Antituberculous therapy was administered in three cases. Complications were limited to scarring in seven cases with keloid formation in two and persistent pain in three cases. This outbreak reinforces the importance of penetrating trauma in this cutaneous mycobacterial infection and emphasizes the emergence of this organism as an important nosocomial pathogen.

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