A Rare Case of Rhinofacial Zygomycosis due to Conidiobolus Infection

Abstract

Background: Rhinofacial zygomycosis is the infection of subcutaneous tissues of maxillofacial region caused by zygomycetes class of fungi. It is commonly caused by the order mucorales and is acute and fulminant. Infections by the order entomophthorales are rare but indolent. Case report:We report an unusual case of rhinofacial zygo mycosis due to Conidiobolus coronatus of the order Entomo phthorales in an immunocompetent adult male to highlight the clinical presentation, diagnosis and treatment. We treated the patient with multiple drugs, that is amphotericinB, cotrimoxazole, and itraconazole along with endoscopic debride ment of nasal polyps with excellent result. Conclusion:Rhinofacial zygomycosis due to entomophthorales is rare but treatable condition. Appropriate histopathological diagnosis and a multipronged approach with timely medical as well as surgical management is the key to clinical cure.

Rhinofacial Conidiobolomycosis: A Case Series and Review of the Literature

“…2 However, surgical debridement of paranasal sinuses followed by antifungal therapy has been proved to be effective in some case reports. 1,6 For example, in case 3, surgical debulking appeared to be a treatment success and helped with improvement in cosmetic outcome too. According to most case reports, cryotherapy has shown little success.…”

“…1,2,3 Adult males in the 20 to 50 years age-group, who engage in outdoor activities or outdoor occupations, are more affected. 1,2 All our 3 patients were male patients within this age-group. However, 2 of them denied of frequent outdoor activities.…”

“…6,7 The disease may spread to all adjacent structures, including the paranasal sinus, and to the subcutaneous tissue of the forehead and periorbital region. 1,2,3 Affected patient may experience chronic symptoms of epistaxis, nasal polyposis, nasal block, nasal discharge, and chronic sinusitis. 1,5 Our third patient had few episodes of epistaxis, and all 3 patients had feeling of nasal blockage.…”

“…5,6 According to reports, this condition could respond to oral itraconazole (200-400 mg/d), ketoconazole (200-400 mg/d), amphotericin-B, and clotrimazole. 1,2 Itraconazole is an effective and relatively safe antifungal drug giving satisfactory results. 2 However, antifungal sensitivity for amphotericin B has demonstrated both sensitive and resistant patterns.…”

“…Conidiobolomycosis is an uncommon, chronic, localized subcutaneous infection. 1,2 This infectious disease is caused by a fungus belonging to the genus Conidiobolus within the order Entomophthorales of class Zygomycetes. 1 Conidiobolus coronatus , Conidiobolus incongruous , and Conidiobolus lamprauges have been reported as the 3 main species of the order Entomophthorales that lead the conidiobolomycosis in humans and animals.…”